From the Guidelines
The best long-acting inhaler for asthma is typically an inhaled corticosteroid (ICS) combined with a long-acting beta-agonist (LABA), such as Advair (fluticasone/salmeterol), Symbicort (budesonide/formoterol), or Breo Ellipta (fluticasone/vilanterol). These combination inhalers are generally used twice daily, except for Breo which is once daily, and provide both anti-inflammatory effects and bronchodilation for 12-24 hours 1. The appropriate dosage depends on asthma severity, with common starting doses being Advair 250/50 mcg twice daily, Symbicort 160/4.5 mcg twice daily, or Breo 100/25 mcg once daily.
Key Points to Consider
- These medications work by reducing airway inflammation through the corticosteroid component while the LABA provides prolonged bronchodilation by relaxing airway muscles 1.
- It's essential to use these inhalers regularly as prescribed, even when feeling well, and to always have a rescue inhaler (like albuterol) available for breakthrough symptoms.
- Proper inhaler technique is crucial for effectiveness - inhale deeply and hold your breath for 10 seconds after each puff.
- These combination inhalers are typically recommended for patients with persistent asthma not well-controlled on ICS alone 1.
- The choice of inhaler may depend on individual patient factors, such as asthma severity, age, and ability to use the inhaler device correctly.
Important Considerations for Treatment
- Inhaled corticosteroids are the preferred controller medication, and studies have demonstrated that they improve asthma control more effectively than any other single long-term control medication 1.
- Combining long-acting beta agonists and inhaled corticosteroids is effective and safe when inhaled corticosteroids alone are insufficient 1.
- For patients with mild persistent asthma, leukotriene receptor antagonists are an alternative, second-line treatment option, but for persons 12 years and older, the addition of long-acting beta2 agonists is preferred 1.
From the Research
Long Acting Inhalers for Asthma
- The use of long acting beta agonists (LABA) and inhaled corticosteroids (ICS) in a single inhaler device has been shown to confer complementary and synergistic effects in the management of asthma 2.
- Combination therapy using LABA and ICS has been found to improve patient compliance, reduce the complexity of treatment, and decrease morbidity associated with the disease 2, 3.
- Studies have demonstrated that Budesonide/formoterol in a single inhaler is an effective maintenance and reliever agent in both adults and children, and is safe and more efficacious than fixed-dosing 2, 4.
Comparison of Different Long Acting Inhalers
- A systematic review comparing the clinical efficacy and safety of formoterol fluticasone (FF) to other ICS/LABA combinations found that FF provided faster onset of bronchodilatation and numerically superior improvement in lung function compared to other formulations 5.
- The review also found that FF had comparable asthma control and a lower risk of pneumonia compared to other ICS/LABA combinations 5.
- Another study found that once-daily fluticasone furoate (FF)/vilanterol reduced the risk of severe exacerbations in asthma compared to FF alone 6.
Key Findings
- Combination therapy with LABA and ICS is a recognized treatment for adults with moderate to severe asthma 3, 4.
- The use of a single inhaler device containing both LABA and ICS simplifies treatment and improves asthma control 2, 3.
- Different ICS/LABA combinations have been found to have varying levels of efficacy and safety, and the choice of agent should be based on individual patient needs and circumstances 5.