From the Guidelines
Salmeterol (Serevent) or formoterol (Foradil) are reasonable first choices for a Long-Acting Beta Agonist (LABA) inhaler, typically dosed twice daily, as they are commonly recommended in various guidelines for COPD management 1.
Key Considerations
- Salmeterol is usually prescribed as 50 mcg twice daily, while formoterol is typically 12 mcg twice daily.
- These medications should not be used as monotherapy for asthma but rather combined with an inhaled corticosteroid to reduce inflammation.
- For COPD patients, LABAs can be used alone or in combination therapy, depending on the severity of symptoms and risk of exacerbations.
Combination Therapy
- Many patients find combination inhalers like fluticasone/salmeterol (Advair) or budesonide/formoterol (Symbicort) more convenient as they provide both a LABA and corticosteroid in one device.
- LABAs work by relaxing bronchial smooth muscle for up to 12 hours, providing sustained bronchodilation.
Newer Options
- Newer once-daily LABAs like indacaterol (Arcapta), vilanterol (part of Breo Ellipta), and olodaterol (Striverdi) may offer better adherence due to less frequent dosing but might not be first-line choices depending on insurance coverage and cost considerations.
Guideline Recommendations
- The European Respiratory Journal study 1 provides an overview of national guidelines for COPD management in Europe, highlighting the role of LABAs in treatment.
- The study 1 also discusses the preferred first treatment choices for COPD patients, including LABAs, and emphasizes the importance of individualized treatment approaches.
From the FDA Drug Label
Formoterol Fumarate Inhalation Solution is indicated for the long-term, twice daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. The recommended dose of Formoterol Fumarate Inhalation Solution is one 20 mcg unit-dose vial administered twice daily (morning and evening) by nebulization Vilanterol is supplied as a disposable light grey and pale blue plastic inhaler containing 2 foil strips, each with 30 blisters (or 14 blisters for the institutional pack). One strip contains fluticasone furoate (50,100 or 200 mcg per blister), and the other strip contains vilanterol (25 mcg per blister).
Reasonable first choice for a Long-Acting Beta Agonist (LABA) inhaler:
- Formoterol and Vilanterol are both options for LABA inhalers.
- However, Vilanterol is often used in combination with an inhaled corticosteroid (such as fluticasone furoate) for the treatment of COPD and asthma.
- Formoterol can be used as a monotherapy for COPD, but not for asthma.
- The choice between Formoterol and Vilanterol depends on the specific patient population and the presence of other respiratory conditions, such as asthma.
- It is essential to consider the patient's medical history, current medications, and potential interactions before selecting a LABA inhaler 2, 3.
- Key points to consider:
- Formoterol: indicated for COPD, not for asthma
- Vilanterol: often used in combination with an inhaled corticosteroid for COPD and asthma
- Patient's medical history and current medications should be considered when choosing a LABA inhaler
From the Research
Long-Acting Beta Agonist (LABA) Inhaler Options
- A reasonable first choice for a LABA inhaler is salmeterol/fluticasone propionate, as it has been shown to improve lung function and asthma symptoms in patients with symptomatic asthma 4.
- Salmeterol/fluticasone propionate is a fixed-dose combination inhalation agent containing a LABA plus a corticosteroid, and it is generally well tolerated in adults, adolescents, and children aged 4-11 years 4.
- Other LABA/ICS combinations, such as formoterol/budesonide, are also available, but the efficacy and safety of these combinations compared to salmeterol/fluticasone propionate are equivocal 4, 5.
Comparison of LABA Inhalers
- Studies have compared the efficacy and safety of salmeterol/fluticasone propionate with other LABA/ICS combinations, such as formoterol/fluticasone and formoterol/beclometasone, and found that salmeterol/fluticasone propionate is a effective and well-tolerated option for maintenance treatment in patients with asthma 5, 6.
- A systematic review of clinical studies found that fluticasone propionate and formoterol fumarate were associated with significantly greater improvement in lung function and better asthma symptom control than budesonide and salmeterol xinafoate, respectively 7.
- The bioequivalence of a generic fluticasone propionate-salmeterol device, Wixela Inhub, has been established, providing an alternative option to Advair Diskus for patients with asthma or COPD requiring intervention with an ICS/LABA 8.