What are examples of Long-Acting Beta Agonists (LABAs) for asthma management?

Examples of Long-Acting Beta Agonists (LABAs) for Asthma Management

The primary examples of Long-Acting Beta Agonists (LABAs) used in asthma management are salmeterol and formoterol, which should never be used as monotherapy but only in combination with inhaled corticosteroids (ICS). 1

Available LABAs for Asthma

• Salmeterol (Serevent) - A bronchodilator with duration of action exceeding 12 hours, highly specific for β-adrenergic receptors with low rates of tremor and palpitations 1
• Formoterol (Foradil) - Similar to salmeterol with duration of action exceeding 12 hours, also with high specificity for β-adrenergic receptors 1

LABA Mechanism and Use

• LABAs are inhaled bronchodilators that provide bronchodilation for at least 12 hours after a single dose 1
• They are administered via inhalation twice daily 1
• LABAs act on different aspects of asthma pathophysiology than inhaled corticosteroids, providing complementary effects 2
• In addition to bronchodilation, LABAs may inhibit mast cell mediator release, plasma exudation, and reduce sensory nerve activation 2

Important Safety Considerations

• LABAs should never be used as monotherapy for long-term control of asthma due to safety concerns including increased risk of severe exacerbations and deaths 1
• The FDA has issued a black-box warning against LABA monotherapy for asthma control 1, 3
• Safety concerns are particularly notable in certain populations:
  • African Americans may have genetic variations affecting LABA effectiveness 1, 3
  • Patients not using inhaled corticosteroids concurrently with LABAs have shown higher mortality 3

Recommended Use in Asthma Management

• LABAs are indicated for step 3 care or higher in patients ≥12 years of age with moderate to severe persistent asthma 1
• They should always be used in combination with inhaled corticosteroids 1
• Common combination formulations include:
  • Salmeterol/fluticasone (Advair) 1, 4
  • Formoterol/budesonide (Symbicort) 1, 5, 4
  • Formoterol/fluticasone 6

Clinical Benefits of LABA/ICS Combinations

• Adding a LABA to ICS therapy is more effective than increasing ICS dose alone for moderate to severe persistent asthma 5, 7
• Combination therapy provides:
  • Improved lung function 7
  • Reduced symptom frequency 7
  • Less use of rescue medication 7
  • Higher quality of life scores 7
  • Lower risk of exacerbations when used with ICS 7

Potential Pitfalls and Caveats

• Regular use of LABAs may lead to tolerance of their bronchoprotective effect (e.g., against exercise-induced bronchoconstriction) 1
• The effectiveness of short-acting beta agonists is generally not impaired in regular LABA users 1
• Patients should be instructed to use their short-acting beta agonist (SABA) for acute symptom relief, not their LABA inhaler 1, 5
• Frequent use of rescue medication (>2 days/week) indicates inadequate asthma control and should prompt reassessment 1