Are inhaled long-acting beta-agonists (LABA) really harmful in adult asthmatics?

Asthmatic patients should be explained that FDA recently issued a black box warning regarding use of LABA for management of asthma. This warning was based on results of the Salmeterol Multicenter Asthma Research Trial (SMART), which found a statistically significant increase in episodes of fatal and near-fatal asthma attacks in patients randomized to salmeterol compared with placebo, primarily affecting African-Americans. There is a fair difference of opinion regarding the role of LABA in treatment of bronchial asthma, and based on the interpretation of evidence in the medical literature, it is for the treating doctor to decide whether the potential for benefit with use of inhaled corticosteroids combined with LABA far outweighs the potential for risk