Concerns with beta2-agonists in pediatric asthma - a clinical perspective

Beta2-adrenoreceptor agonists (beta 2-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 beta 2-agonists, such as masking patients' perception of worsening asthma, desensitization and downregulation of the beta 2-adrenoreceptor, pro-inflammatory effects of beta 2-agonists, pharmacogenetic effects of beta 2-adrenoreceptor polymorphisms and age related differences in pathophysiology of asthma. In this paper, we review beta 2-receptor pharmacology, discuss the concerns regarding treatment with beta 2-agonists in childhood asthma, and provide suggestions for clinical pediatric practice in the light of current literature. (C) 2016 Elsevier Ltd. All rights reserved.