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Short-acting [beta]-adrenergic receptor agonists have pharmacologically predictable dose-related and potency-related adverse effects, including tachycardia and tremor, and they also affect serum potassium and glucose. These effects all show tolerance with continued exposure. The potential for arrhythmia is increased by comorbidity and hypoxemia. Nonpharmacologically predictable effects include airway hyperresponsiveness to nonspecific and specific stimuli, including allergen and exercise, and increased airway inflammation. Genetic variants of the [beta]-adrenergic receptor alter susceptibility to adverse effects of [beta]-agonists on airway function. The impact of the enantiomers of [beta]-agonists on adverse effects remains unclear. The two epidemics of asthma death among young people were temporally associated with introduction of potent short-acting [beta]-agonists (isoproterenol and fenoterol) and appear to be related to adverse effects of these drugs on airway function and airway hyperresponsiveness rather than to cardiotoxicity. Compared with short-acting agents, long-acting [beta]-agonists show similar but less pronounced pharmacologically predictable effects, and they have not been shown to increase airway hyperresponsiveness in adults. Postmarketing surveillance studies have not suggested significant adverse effects of long-acting [beta]-agonists on morbidity and mortality. (J Allergy Clin Immunol 2002;110:S322-8.)

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