From the Guidelines
The best ICS-LABA combination for most adults with asthma or COPD is fluticasone-vilanterol (Breo Ellipta), as it offers once-daily dosing, which may improve adherence, and has been shown to reduce exacerbations and improve lung function 1. For asthma, typical starting doses include fluticasone-salmeterol 100/50mcg twice daily, budesonide-formoterol 160/4.5mcg twice daily, or fluticasone-vilanterol 100/25mcg once daily, with dose adjustments based on symptom control. For COPD, higher doses are often used. The choice should consider the patient's specific condition, symptom pattern, inhaler technique abilities, insurance coverage, and preference for dosing frequency. Some key points to consider when using ICS-LABA combinations include:
- Long-term monotherapy with ICSs is not recommended (Evidence A) 1.
- Long-term treatment with ICSs may be considered in association with LABAs for patients with a history of exacerbations despite appropriate treatment with long-acting bronchodilators (Evidence A) 1.
- The LABA/ICS combination may have a modest effect on overall mortality, but the primary adverse effect attributed to the LABA/ICS combination is an increased risk of pneumonia 1. Patients should be taught proper inhaler technique and reminded to rinse their mouth after use to prevent oral thrush. Regular follow-up is essential to assess response and adjust therapy as needed. Some studies have shown that the LABA/LAMA combination can increase lung function to a greater degree than a LAMA alone, but more studies are needed to determine the effect of the LABA/LAMA combination on other patient-centred outcomes 1. In general, the choice of ICS-LABA combination should be individualized based on the patient's specific needs and circumstances.
From the Research
ICS-LABA Combinations
The choice of the best Inhaled Corticosteroid (ICS) - Long-Acting Beta Agonist (LABA) combination for asthma treatment depends on various factors, including the patient's response to treatment, the severity of asthma, and the presence of any comorbidities. Some studies have compared the efficacy and safety of different ICS-LABA combinations:
- Fluticasone/formoterol has been shown to be as effective as fluticasone/salmeterol in the treatment of asthma, with a more rapid onset of action 2.
- Budesonide/formoterol has been compared to salmeterol/fluticasone propionate, with results showing that budesonide/formoterol provides similar improvements in lung function and asthma control, but with a reduced risk of hospitalizations and emergency room visits 3.
- Salmeterol/fluticasone propionate has been compared to its mono-components and other LABA/ICS combinations, with results showing that it is an effective and safe treatment option for asthma 4.
Comparison of ICS and LABA Options
Some studies have compared the efficacy and safety of different ICS and LABA options:
- Fluticasone has been shown to be more effective than budesonide in improving lung function and asthma symptom control 5.
- Formoterol has been shown to be more effective than salmeterol in improving lung function and asthma symptom control 5.
- Single inhaler combination regimens, such as budesonide/formoterol and fluticasone/salmeterol, have been shown to be more effective than monotherapy alone in improving treatment outcomes 5.
Key Findings
Some key findings from the studies include:
- Fluticasone/formoterol has a more rapid onset of action compared to fluticasone/salmeterol 2, 6.
- Budesonide/formoterol provides similar improvements in lung function and asthma control as salmeterol/fluticasone propionate, but with a reduced risk of hospitalizations and emergency room visits 3.
- Salmeterol/fluticasone propionate is an effective and safe treatment option for asthma, with a comparable efficacy and safety profile to other LABA/ICS combinations 4.