What is Nebulized Long-Acting Beta-Agonist (LABA)?

From the Guidelines

Nebulized long-acting beta-agonists (LABAs) are recommended as a maintenance therapy for patients with moderate to severe COPD to reduce the risk of acute exacerbations and improve quality of life, as evidenced by a 2015 study published in Chest 1. The use of nebulized LABAs, such as formoterol and arformoterol, has been shown to provide sustained bronchodilation and improve lung function in patients with COPD.

• Key benefits of nebulized LABAs include:
  • Reduced risk of moderate and severe exacerbations
  • Improved quality of life, as measured by the SGRQ score
  • Significant improvements in lung function
• The standard dose for formoterol is 20 mcg twice daily, while arformoterol is given as 15 mcg twice daily.
• Nebulized LABAs are particularly useful for patients who have difficulty using inhalers or require higher medication doses.
• Common side effects include tremor, headache, and tachycardia.
• According to the 2017 GOLD strategy document 1, LABAs should be used in combination with an inhaled corticosteroid in asthma patients to prevent serious asthma-related events.
• Proper nebulizer cleaning and maintenance are essential to prevent infection and ensure effective medication delivery.
• The 2017 European Respiratory Society/American Thoracic Society guideline 1 also recommends the use of LABAs in patients with COPD, highlighting their effectiveness in reducing exacerbations and improving lung function.

From the FDA Drug Label

Use of long-acting beta2-adrenergic agonists (LABA) as monotherapy [without inhaled corticosteroids (ICS)] for asthma is associated with an increased risk of asthma-related death. Available data from controlled clinical trials also suggest that use of LABA as monotherapy increases the risk of asthma-related hospitalization in pediatric and adolescent patients The increased risk of asthma-related death is considered a class effect of LABA, including olodaterol, one of the active ingredients in STIOLTO RESPIMAT.

Nedulized LABA is associated with an increased risk of asthma-related death and hospitalization when used as monotherapy without inhaled corticosteroids (ICS). This is considered a class effect of LABA. 2

From the Research

Nedulized LABA Overview

• The use of long-acting beta2-agonists (LABAs) in combination with inhaled corticosteroids (ICS) is a common treatment approach for asthma and chronic obstructive pulmonary disease (COPD) 3, 4.
• LABAs, such as formoterol and salmeterol, are used to control bronchoconstriction, while ICS, such as fluticasone propionate and budesonide, are used to control inflammation 3, 4.

Treatment Guidelines and Recommendations

• Treatment guidelines recommend the use of LABAs in combination with ICS for patients with uncontrolled asthma or COPD, particularly those with a history of frequent or severe exacerbations 5, 4.
• The use of ICS/LABA combinations is recommended for patients with high blood eosinophil counts or concomitant asthma 5.
• However, real-world data suggest that clinicians may not always adhere to these guidelines, and ICS may be overused in some cases 5.

Nebulized LABA Therapy

• Nebulized bronchodilator therapy, including LABAs, is commonly used in the treatment of COPD exacerbations 6.
• However, a study found that patients may miss a significant proportion of their scheduled nebulized bronchodilator doses, highlighting the need for alternative treatment approaches, such as metered-dose inhalers (MDIs) with valved holding chambers (VHCs) 6.

As-Needed ICS-LABA Therapy

• Recent studies have explored the use of as-needed ICS-LABA therapy in mild asthma patients, with mixed results 7.
• Some studies have shown that as-needed ICS-LABA therapy may be effective in preventing exacerbations and improving asthma control, while others have raised concerns about the lack of evidence supporting this approach 7.