GPs advised to ignore beta-agonist warning

Calls for GPs to stop prescrib-ing long-acting beta-agonists (LABAs) to patients with chronic asthma have been dismissed by experts.

An editorial in the Journal of the Royal Society of Medicine called for LABAs only to be given by specialists, not GPs, because, when used as monotherapy, the drugs had been shown to increase the risk of severe asthma episodes and death.

But Professor Martyn Partridge, a member of the British Thoracic Society (BTS) executive committee, who helped draw up current BTS-SIGN asthma guidelines, said there was no justification for moving LABA prescribing away from GPs.

He also criticised advice to give anticholinergic agents to patients who failed to respond to steroids because there was not yet sufficient evidence to promote this point of view.

Professor Neil Barnes, who co-chairs the pharmacology section of the BTS-SIGN asthma guidelines, said the article was 'unbalanced'.

'The evidence is that, if we use LABAs with corticosteroids as indicated in the guidelines, they're effective and safe,' he said.

The editorial follows a US trial into the LABA salmeterol, involving 26,355 patients, which was stopped early because the number of deaths from respiratory disease and asthma in the LABA arm was found to exceed that of the placebo arm.

However, the study was conducted in the US, where deprived asthma patients are more likely to take LABAs alone to save money. Without corticosteroids to reduce the inflammation that causes asthma, the condition is unlikely to be controlled and this could account for the additional risk in the LABA arm of the trial.

J Roy Soc Med 2006; 99: 382-3

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