Examples of Long-Acting β2-Agonists (LABAs)
The primary long-acting β2-agonists are salmeterol and formoterol, which provide bronchodilation for more than 12 hours with twice-daily dosing. 1
Traditional LABAs (12-hour duration)
- Salmeterol (Serevent) - Twice-daily dosing, slower onset of action
- Formoterol (Foradil) - Twice-daily dosing, rapid onset of action (similar to short-acting agents)
Both medications are highly specific for β2-adrenergic receptors, resulting in low rates of tremor, palpitations, or tachycardia 1.
Ultra-Long-Acting β2-Agonists (24-hour duration)
Newer "ultra-LABAs" have been developed for once-daily administration:
- Indacaterol - Approved for COPD treatment in Europe and the USA, provides 24-hour bronchodilation with once-daily dosing 2
- Olodaterol - In development/approved for once-daily use
- Vilanterol - Available in combination products for once-daily dosing
- Carmoterol, milveterol, abediterol - Various stages of development 2, 3
Critical Safety Considerations
LABAs must never be used as monotherapy for asthma - they should only be prescribed in combination with inhaled corticosteroids 1, 4. This is a critical safety requirement due to concerns about increased severe exacerbations and deaths when LABAs are used alone in asthma patients 1.
For COPD patients, LABAs can be used as monotherapy or preferably in combination with long-acting muscarinic antagonists (LAMAs), with the LAMA/LABA combination being the preferred first-line approach over LABA/ICS combinations 5, 6.
The once-daily ultra-LABAs offer potential advantages in convenience and adherence, though their long-term safety profiles continue to be evaluated 3, 7.