For many of our patients with moderate or severe asthma, we continue to prescribe the long-acting beta agonists. In many instances they provide dramatic, sometimes life-altering benefit. But we also take seriously the new warnings about the risks associated with their use. When we recommend their use, we do so as part of a comprehensive program of asthma management. This program includes avoiding as much as possible the triggers that cause your asthma and allergies to flare; periodic review of your medications to ensure the optimal treatment regimen; monitoring for deteriorations in your asthma; and developing a plan to deal with flare-ups before they become dangerously severe (your “asthma action plan”). You can help by taking your medications as prescribed, being alert to signs that your asthma is worsening, communicating with your asthma providers when you are not doing well, and keeping your regular follow-up medical appointments. We share with you the same goal: an active and safe life unrestricted by asthma or its treatments. Together we can achieve this goal, using the best available treatment program.
19 publications describing 10 trials of adults were included in the review . Studies that compared reduced dose ( mean 60% reduction) ICS/LABA combination to a fixed moderate/high dose ICS found no significant difference in severe exacerbations requiring oral corticosteroids ( RR , 95% CI to ), withdrawal due to worsening asthma ( RR , 95% CI to ) or airway inflammation. There were also significant improvements in FEV1 (change from baseline WMD , 95% CI to ), morning & evening PEF and percent rescue free days with LABA. Two studies provided outcomes for a reduced/tapering ICS dose comparison. More participants receiving the LABA/reduced ICS combination achieved a reduction in ICS dose reaching significance in one study . A significant reduction of 253 mcg BDP was achieved in one study .
A total of 15 studies of good methodological quality met the inclusion criteria by randomly assigning 7814 participants with predominantly poorly reversible, severe COPD. Data were most plentiful for the FPS combination. Exacerbation rates were significantly reduced with combination therapies (rate ratio , 95% CI to , 6 studies, N = 5601) compared with ICS alone. The mean exacerbation rate in the control (ICS) arms of the six included studies was exacerbations per participant per year (range to ), and we would expect this to be reduced to a rate of (95% CI to ) among those given combination therapy. Mortality was also lower with the combination (odds ratio (OR) , 95% CI to , 12 studies, N = 7518) than with ICS alone, but this was heavily weighted by a three-year study of FPS. When this study was removed, no significant mortality difference was noted. The reduction in exacerbations did not translate into significantly reduced rates of hospitalisation due to COPD exacerbation (OR , 95% CI to , 10 studies, N = 7060). Lung function data favoured combination treatment in the FPS, BDF and MF/F trials, but the improvement was small. Small improvements in health-related quality of life were measured on the St George's Respiratory Questionnaire (SGRQ) with FPS or BDF compared with ICS, but this was well below the minimum clinically important difference. Adverse event profiles were similar between the two treatments arms, and rates of pneumonia when it was diagnosed by chest x-ray (CXR) were lower than those reported in earlier trials.
β 2 agonists are abused by athletes and bodybuilders as anabolic performance-enhancing drugs and their use has been banned by the World Anti-Doping Agency except for certain drugs that people with asthma may use; they are also used illegally to try to promote the growth of livestock.  A 2011 meta-analysis found no evidence that inhaled β₂-agonists improve performance in healthy athletes and found that the evidence was too weak to assess whether systemic administration of β₂-agonists improved performance in healthy people. 
β 2 agonists are abused by athletes and bodybuilders as anabolic performance-enhancing drugs and their use has been banned by the World Anti-Doping Agency except for certain drugs that people with asthma may use; they are also used illegally to try to promote the growth of livestock.  A 2011 meta-analysis found no evidence that inhaled β₂-agonists improve performance in healthy athletes and found that the evidence was too weak to assess whether systemic administration of β₂-agonists improved performance in healthy people.