What are examples of Long-Acting Beta Agonist (LABA) medications?

Examples of Long-Acting Beta Agonist (LABA) Medications

Long-Acting Beta Agonists (LABAs) include salmeterol, formoterol, indacaterol, olodaterol, and vilanterol, which are used for the management of asthma and COPD, typically in combination with other medications rather than as monotherapy. 1

Common LABAs and Their Characteristics

• 12-hour duration LABAs:

  • Salmeterol: Has a 12-hour duration of action with twice-daily dosing regimen 2
  • Formoterol: Has a 12-hour duration of action with twice-daily dosing but unlike salmeterol, has a rapid onset of action 2

• 24-hour duration LABAs (Ultra-LABAs):

  • Indacaterol: Approved for COPD with 24-hour duration allowing once-daily dosing 2
  • Olodaterol: Ultra-LABA with 24-hour duration of action 1, 2
  • Vilanterol: Ultra-LABA with 24-hour duration, often used in combination products 1, 3
  • Other ultra-LABAs in development: Milveterol, carmoterol, and abediterol 2, 4

Role in Asthma and COPD Management

• LABAs are not recommended as monotherapy for asthma but should be used in combination with inhaled corticosteroids (ICS) 1
• In COPD, LABAs improve lung function, reduce exacerbation frequency, and improve health-related quality of life 1
• LABAs may be used before exercise to prevent exercise-induced bronchoconstriction (EIB), but duration of action does not exceed 5 hours with chronic, regular use 1

Combination Therapy

• LABA/ICS combinations are preferred for patients whose asthma is not controlled with ICS alone 5, 3

• Available LABA/ICS combinations include:

  • Fluticasone propionate/salmeterol 3
  • Budesonide/formoterol 3
  • Beclometasone dipropionate/formoterol 3
  • Fluticasone propionate/formoterol 3
  • Newer combinations: mometasone/formoterol, fluticasone furoate/vilanterol, mometasone/indacaterol 3

• LABA/LAMA combinations have been developed for COPD and appear to increase lung function to a greater degree than a LAMA alone 1

Important Clinical Considerations

• LABAs should be withheld before challenge testing: 24 hours for standard LABAs and >72 hours for ultra-LABAs 1
• LABAs should not be used as monotherapy for asthma due to safety concerns 1
• In COPD, LAMA therapy has shown greater effect on reducing exacerbations compared to LABAs collectively, though individual LABAs may perform differently in specific populations 1

Pharmacological Benefits

• LABAs not only provide bronchodilation but also inhibit mast cell mediator release and plasma exudation 6
• Corticosteroids increase the expression of beta2-receptors, which may protect against the loss of beta2-receptors during long-term LABA exposure 6
• The combination of LABAs with ICS may result in additive or synergistic effects in controlling inflammation and airway remodeling 5, 6

Understanding the specific properties of different LABAs helps clinicians select the most appropriate medication based on the patient's condition, symptom pattern, and dosing preferences.