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Some studies suggest that regular use of short-acting beta agonists (SABAs) does not significantly improve asthma control and may worsen asthma severity and mortality, while other studies highlight their effectiveness in providing quick relief when used appropriately.
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Short-acting beta agonists (SABAs) are a cornerstone in the management of asthma, primarily used for quick relief of acute symptoms. These medications work by stimulating beta-2 adrenergic receptors in the lungs, leading to bronchodilation and rapid symptom relief .
There has been significant debate regarding the regular use of SABAs. Studies have shown that regular use of SABAs does not provide significant benefits over as-needed use and may even worsen asthma control. For instance, a randomized controlled trial indicated that regular use of fenoterol led to worsened asthma control despite the concurrent use of inhaled corticosteroids . Additionally, regular SABA use has been associated with increased asthma severity and mortality, particularly highlighted by the asthma mortality epidemics in New Zealand linked to fenoterol .
Current guidelines recommend the use of SABAs on an as-needed basis rather than regular use. This approach is supported by evidence showing that as-needed use is sufficient for symptom relief without the adverse effects associated with regular use . Studies have found no significant differences in airway calibre measurements between regular and as-needed use, but regular use required less rescue medication and resulted in fewer days with asthma symptoms.
SABAs are known to have several dose-related and potency-related adverse effects, including tachycardia, tremor, and alterations in serum potassium and glucose levels. These effects tend to show tolerance with continued exposure . The potential for arrhythmia is increased in patients with comorbidities and hypoxemia .
SABAs can also lead to airway hyperresponsiveness to nonspecific and specific stimuli, including allergens and exercise, and increased airway inflammation. Genetic variants of the beta-adrenergic receptor can alter susceptibility to these adverse effects . The adverse effects of SABAs on airway function and hyperresponsiveness have been implicated in the increased asthma mortality observed in the past .
Long-acting beta agonists (LABAs) provide prolonged bronchodilation and are used for long-term asthma control. Compared to SABAs, LABAs have similar but less pronounced adverse effects and have not been shown to increase airway hyperresponsiveness in adults . LABAs are particularly beneficial when added to inhaled corticosteroids, improving lung function and reducing the need for rescue medication .
In summary, while SABAs are essential for the quick relief of asthma symptoms, their regular use is not recommended due to potential adverse effects and lack of additional benefits over as-needed use. Current guidelines support the as-needed use of SABAs to manage acute symptoms effectively while minimizing risks. Long-acting beta agonists, when used in conjunction with inhaled corticosteroids, offer a safer and more effective option for long-term asthma control.
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