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The new longer-acting high potency inhaled beta-agonist, salmeterol (Serevent) has been approved for use in the UK since 1990. Since its approval, reports of sudden severe attacks of asthma or of patients found dead holding their salmeterol inhaler have raised concerns!
The manufacturer states that there is no evidence that salmeterol has greater efficacy or additional benefit to short-acting inhaled beta-agonists in patients with worsening asthma and warns it should not be initiated in such patients – presumably because they could do without the embarrassing publicity! Because salmeterol has a delayed onset of action short-acting beta-agonists are usually prescribed alongside as supplemental. Known side-effects include headache, cough, diarrhoea, muscle cramps, nausea, nervousness, palpitations, stomach pain, tachycardia (abnormally rapid heartbeat), trembling, allergic dermatitis and bronchospasm.
A recent study with inhaled salmeterol and formoterol (both long-acting beta2-agonists) have shown that both agents cause an increase in heart rate and a lowering of blood pressure “within minutes of inhalation” in healthy subjects. Over eight hours both formoterol and salmeterol caused dose-related changes in heart rate, diastolic blood pressure, plasma glucose and potassium concentrations.
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