Currently, for acute severe asthma, guideline recommendations suggest repeated use of inhaled short-acting beta-2 agonists
, up to 10 puffs repeated every 10 to 20 minutes, or repeated nebulised dosing.
It is well documented that due to their excitation effect on the cardiac conduction system, beta-2 agonists
used in the treatment of acute asthmatic attacks frequently increase the incidence of cardiac arrhythmias (8, 27).
Thus, this patient should be treated with a combination of inhaled corticosteroid and long acting beta-2 agonist
, plus tiotropium.
Despite years of moderate to high doses of inhaled corticosteroids and beta-2 agonists
, they still suffered episodes of dyspnea, expectoration, coughing, wheezing, chest tightness more than two times a week, and waking up at night with asthma symptoms more than two times a week.
Although the guidelines suggest that all asthmatics should have access to a rescue medication, fewer than 40 percent of the Medicaid patients received an inhaled short-acting beta-2 agonist
during the study year.
The American Academy of Allergy and Immunology has been concerned that media reports which question the use of beta-2 agonists
to treat asthma have caused great anxiety among asthmatics and the public.
For decades, inhaled beta-2 agonists
were strongly associated with adverse cardiac effects in COPD patients with pre-existing cardiovascular disease and an increased risk of CHF decompensation (adjusted OR 3.
Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta-2 agonists
for the treatment of chronic asthma in children under the age of 12 years.