The addition of long-acting beta-agonists to inhaled corticosteroids in asthma.

Abstract

PURPOSE OF REVIEW:

although long-acting beta-agonists (LABAs) have been used for two decades, with many studies showing benefit versus increasing inhaled corticosteroid (ICS), controversy regarding safety has resulted in the United States Food and Drug Administration (FDA) recently mandating label changes restricting LABA use. This review addresses these safety concerns together with clinical studies and meta-analyses assessing the appropriate use of LABAs.

RECENT FINDINGS:

effective use of LABAs requires sufficient ICS to control inflammation. Underuse of ICS, which is often manifest by exacerbations, may reflect undue emphasis on alleged steroid-sparing effects of LABAs. The FDA meta-analysis found that LABA with mandatory ICS was not associated with increased risks of serious adverse events. The role of LABA with ICS as initial therapy in steroid-naïve patients is debated, as is LABA use in children, with data indicating less benefit than in adults. The FDA recommendation that LABA be withdrawn once control is achieved remains problematic, as greater ICS reduction can be achieved when LABA is continued.

SUMMARY:

the safe use of LABAs, which are clearly effective in many patients with moderate to severe asthma, requires high compliance with ICS therapy, which is best assured if ICS and LABA are provided in a single inhaler.

• Authors: Malcolm R Sears (Affiliation: McMaster University, Firestone Institute for Respiratory Health, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. searsm at mcmaster.ca)
• Journal: Current opinion in pulmonary medicine (Curr Opin Pulm Med) Vol. 17 Issue 1 Pg. 23-8 (Jan 2011) ISSN: 1531-6971 [Electronic] United States
• PMID: 21045700 (Publication Type: Journal Article, Review)

Chemical References

• Adrenal Cortex Hormones
• Adrenergic beta-Agonists

Topics

• Administration, Inhalation
• Adrenal Cortex Hormones (administration & dosage, therapeutic use)
• Adrenergic beta-Agonists (therapeutic use)
• Asthma (drug therapy)
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Humans
• Treatment Outcome