A 2004 meta-analysis of Long-Acting Beta Agonists (LABA) concluded that they were shown to increase severe and life-threatening asthma exacerbations as well as asthma-related deaths. [i]
Long-acting beta agonists; Salmeterol and Formoterol are sold in New Zealand as Serevent and Oxis or in combination with inhaled corticosteroids as Symbicort, Seretide and Vannair.
A previous meta-analysis of beta agonists concluded that regular beta agonist use for at least one week resulted in tolerance to their effects and poorer disease control compared to placebo.[ii] Regular use of beta agonist increased airway inflammation and increased asthma exacerbations. [iii]
The meta-analysis commented on the development of receptor desensitisation and down-regulation along with rebound bronchoconstriction after sudden withdrawal of beta agonists. It was concluded that “to date no randomised trials (of beta agonists in asthma) have demonstrated a reduction in disease progression or in mortality.” [i]
The same meta-analysis observed that if a study were funded or sponsored by a pharmaceutical company it was more likely to conclude that beta-agonists were helpful (73%) whereas only 10% of studies not declaring such support concluded that beta agonists were helpful. [i]
Comment
Doctors at Gisborne hospital, Bruce Duncan and Patrick McHugh, have authored two Buteyko studies. Based on the success of these and other studies they recommend non-pharmacological approaches to asthma management such as Buteyko need to be considered if we are to reduce the mortality and morbidity resulting from beta agonist use. [iv] [v] [vi] [vii] [viii] [ix] [x] [xi] [xii]
Buteyko Breathing Clinic practitioners' advice regarding medication use is consistent with the advice of the New Zealand Guidelines Group: to use beta agonists only when necessary with early use of inhaled (and/or oral) corticosteroids.
Follow these links to discussions on beta agonists and asthma taken from the NZMJ:
Long-acting beta agonists—prescribe with care Journal of the New Zealand Medical Association, 07-July-2006, Vol 119
Julian Crane, Professor, Department of Medicine, Wellington School of Medicine and Health Sciences, Wellington
Beta agonists and asthma Journal of the New Zealand Medical Association, 13-October-2006, Vol 119 No 1243
Patrick McHugh, Clinical Director, Emergency Department, Gisborne Hospital, Gisborne
Bruce Duncan, Public Health Physician, Tairawhiti District Health, Gisborne
[i] Salpeter, SR, Buckley NS, Ormiston TM and Salpeter EE., Meta-analysis: Effect of Long-Acting -Agonists on severe asthma exacerbations and asthma-related deaths. Annals of Internal Medicine. 2006; 144: 904-912.
[ii] Salpeter SR, Ormiston TM, Salpeter EE. Meta-analysis: Respiratory tolerance to regular ß2-Agonist use in patients with asthma. Ann Intern Med. 2004; 140:802-13.
[iii] Spitzer WO et al., The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med. 1992 Feb 20; 326(8):560-1
[iv] McHugh, P., Aitcheson, F., Duncan, B. and Houghton, F. Buteyko Breathing Technique for asthma: an effective intervention New Zealand Medical Journal 12 December 2003 Vol. 116 No 1187
[v] McHugh, P., Aitcheson, F., Duncan, B. and Houghton, F. Buteyko breathing technique and asthma in children: a case series New Zealand Medical Journal 19 May 2006, V. 119 No 1234
[vi] Bowler, S.D., Green, A. and Mitchell, C.A. Buteyko breathing techniques in asthma: a blinded randomised controlled trial Medical Journal of Australia 1998; 169: 575-578
[vii] Opat A.J., Cohen M.M., Bailey M.J., Abramson M.J. A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video. J Asthma 2000; 37(7):557-64
[viii] Cooper, S., Osborne, J., Newton, S., Harrison, V., Thompson Coon, J., Lewis S. and Tattersfield, A. Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial Thorax 2003; 58:674-679
[ix] Slader, C.A., Reddel, H.K., Spencer, L.M., Belousova, E.G., Armour, C.L., Bosnic-Anticevich, S.Z., Thien, F.C.K., Jenkins, C.R. Double blind randomised controlled trial of two different breathing techniques in the management of asthma Thorax 2006;61:651-656
[x] Cowie, R.L., Conley, D.P., Underwood, M.F., Reader P.G., A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma Respiratory Medicine May 2008 (Vol. 102, Issue 5, Pages 726-732)
[xi] Zahra Mohamed Hassan, Nermine Mounir Riad, Fatma Hassan Ahmed Effect of Buteyko breathing technique on patients with bronchial asthma Egyptian Journal of Chest Diseases and Tuberculosis (2012) 61, 235–241
[xii] Narwal Ravinder , Bhaduri S.N. , Misra Ajit A Study of effects of Buteyko Breathing Technique on Asthmatic Patients Indian Journal of Physiotherapy and Occupational Therapy 2012, Volume: 6 Issue : 4
