Controversies regarding long-acting 2-agonistsKhianey, Reena; Oppenheimer, JohnCurrent Opinion in Allergy & Clinical Immunology: August 2011 - Volume 11 - Issue 4 - p 345–354 doi: 10.1097/ACI.0b013e328348a82e Pharmacotherapy and evidence based medicine: Edited by David A. Khan and Enrico Compalati Abstract Author Information Purpose of review: This review examines the literature regarding the efficacy and safety of long-acting β2-agonists as add-on therapy to inhaled corticosteroids. Recent findings: The Global Initiative for Asthma (GINA) 2009 guidelines and the National Heart, Lung, and Blood Institute (NHLBI) 2007 asthma guidelines recommend adding long-acting β2-agonists to patients inadequately controlled on inhaled corticosteroids. These recommendations must be balanced against published data which demonstrate a signal of increased morbidity and mortality with use of long-acting β2-agonists. These conflicting data raise the question of whether or not there may be genotypic or phenotypic discriminators leading to disparate responses to long-acting β2-agonists. Summary: The combination of long-acting β2-agonists and inhaled corticosteroids demonstrates improvement in asthma control and exacerbation rates; however, long-acting β2-agonists are not recommended for use as monotherapy or without optimization of inhaled corticosteroid dose. Although the majority of asthmatic patients appear to benefit from the addition of long-acting β2-agonists, there are concerns that a small proportion of patients, including steroid-naïve patients and African Americans, may not obtain such benefits. Thus far, studies have not clearly demonstrated genotypic or phenotypic differences explaining the variability in response. aUMDNJ-New Jersey Medical School, Newark bPulmonary and Allergy Association, Summit, New Jersey, USA Correspondence to John Oppenheimer, MD, UMDNJ-New Jersey Medical School, Pulmonary and Allergy Association, 1 Springfield Ave., Summit, NJ 07801, USATel: +1 973 267 9393; fax: +1 973 540 0472; e-mail: Nallopp@pol.net Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.