Which Long-Acting Beta Agonist (LABA) inhaler is recommended?

From the Guidelines

The most recommended Long-Acting Beta Agonist (LABA) inhaler is formoterol (Foradil) 12 mcg twice daily, due to its efficacy in reducing exacerbation risk and improving lung function in patients with COPD, as supported by recent guidelines 1.

Key Points to Consider

• LABAs are typically prescribed as part of combination therapy with inhaled corticosteroids to reduce exacerbation risk in patients with COPD.
• Formoterol (Foradil) is a commonly recommended LABA, with a standard dosing of 12 mcg twice daily.
• Other LABAs, such as salmeterol (Serevent), vilanterol (part of Breo Ellipta), and indacaterol (Arcapta), may also be considered, but formoterol is generally preferred due to its faster onset of action and longer duration of effect.
• Patients should be monitored for potential side effects, including tremor, tachycardia, and hypokalemia, particularly when initiating therapy.

Guidelines and Recommendations

• The European Respiratory Journal guidelines recommend the use of LABAs, including formoterol, as part of combination therapy for COPD management 1.
• The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines also recommend the use of LABAs, including formoterol, for patients with COPD who have a history of exacerbations or persistent symptoms despite treatment with short-acting bronchodilators 1.

Important Considerations

• LABAs should not be used as rescue medication or as monotherapy for asthma due to safety concerns.
• Patients with COPD should be assessed for their risk of exacerbations and treated accordingly, with LABAs being considered for those at high risk.
• The use of LABAs in combination with inhaled corticosteroids should be individualized based on patient response and risk of side effects.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Long-Acting Beta Agonist (LABA) Inhalers

• The recommended LABA inhaler may vary depending on the patient's specific needs and medical history.
• Studies have shown that combination inhalers containing a LABA and an inhaled corticosteroid (ICS) are effective in controlling asthma symptoms and reducing the risk of exacerbations 2, 3, 4.
• Examples of LABA/ICS combination inhalers include:
  • Salmeterol/fluticasone propionate (Seretide/Advair) 2, 3, 4
  • Formoterol/budesonide (Symbicort) 2, 3, 5
  • Beclometasone/formoterol (Foster) 3
• The choice of LABA inhaler may depend on factors such as the patient's age, asthma severity, and previous response to treatment.
• It is essential to consult with a healthcare professional to determine the most suitable LABA inhaler for each individual patient.

Specific LABA Inhalers

• Salmeterol/fluticasone propionate has been shown to improve lung function and asthma symptoms, and is associated with a corticosteroid-sparing effect 4.
• Formoterol/budesonide has been shown to reduce the risk of severe asthma exacerbations and hospitalizations, and is approved for use as maintenance and reliever therapy in some countries 3, 5.
• Beclometasone/formoterol has been shown to be effective in controlling asthma symptoms, but its use is less well-studied compared to other LABA/ICS combination inhalers 3.

Considerations for LABA Inhaler Selection

• The patient's individual needs and medical history should be taken into account when selecting a LABA inhaler.
• The potential benefits and risks of each LABA inhaler should be carefully considered, including the risk of pneumonia associated with ICS use 6.
• Regular monitoring and follow-up with a healthcare professional are essential to ensure the optimal use of LABA inhalers and to minimize potential adverse effects.