Concerns with beta2-agonists in pediatric asthma - a clinical perspective. (January 2017)

• Record Type: Journal Article
• Authors: Kersten, Elin T.G.; Koppelman, Gerard H.; Thio, Bernard J.
• Is Part Of: Paediatric respiratory reviews. Volume 21(2017)
• Page Start: 80
• Page End: 85
• Publication Date: 2017-01
• Subjects: β2-agonists -- Tolerance -- Asthma -- Genetic polymorphisms; cAMP cyclic adenosine monophosphate -- BARGE Beta Adrenergic Response by Genotype -- β2AR β2-adrenoreceptor -- BHR bronchial hyperresponsiveness -- EIB exercise induced bronchoconstriction -- FDA food and drug administration -- FEV1 forced expiratory volume in 1 sec -- ICS inhaled corticosteroid -- LABA long acting β2-agonist -- LARGE Longacting β2-Adrenergic Response by Genotype -- LTRA leukotriene receptor antagonist -- PKA protein kinase A -- SABA short acting β2-agonist -- SAE serious adverse events -- SMART Salmeterol Multi-center Asthma Research Trial -- SNP Single Nucleotide Polymorphism -- SNS Serevent Nationwide Surveillance; Pediatric respiratory diseases -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Respiratory Therapy -- Periodicals; Child -- Periodicals; Appareil respiratoire -- Infections, chez l'enfant -- Périodiques; Appareil respiratoire -- Maladies, chez l'enfant -- Périodiques; 618.922
• DOI: 10.1016/j.prrv.2016.05.006
• Languages: English
• ISSNs: 1526-0542

Abstract

Summary: Beta2-adrenoreceptor agonists (β2-agonists) are extensively used in the treatment of childhood asthma. However, there have been concerns regarding their adverse effects and safety. In 2005, the FDA commissioned a "Black Box Warning" communicating the potential for an increased risk for serious asthma exacerbations or asthma related deaths, with the regular use of LABAs. In a meta-analysis of controlled clinical trials, the incidence of severe adverse events appeared to be highest in the 4-11 year age group. Several mechanisms have been proposed regarding the risk of regular use of β2-agonists, such as masking patients' perception of worsening asthma, desensitization and downregulation of the β2-adrenoreceptor, pro-inflammatory effects of β2-agonists, pharmacogenetic effects of β2-adrenoreceptor polymorphisms and age related differences in pathophysiology of asthma. In this paper, we review β2-receptor pharmacology, discuss the concerns regarding treatment with β2-agonists in childhood asthma, and provide suggestions for clinical pediatric practice in the light of current literature.