From the Guidelines
Twice daily Long-Acting Beta-Agonist (LABA) inhalers for asthma are Salmeterol and Formoterol.
Key Characteristics of LABAs
- These medications are bronchodilators that have a duration of bronchodilation of at least 12 hours after a single dose 1.
- They are used in combination with Inhaled Corticosteroids (ICSs) for long-term control and prevention of symptoms in moderate or severe persistent asthma 1.
- Salmeterol is administered via a dry powder inhaler (DPI) at a dose of 50 mcg every 12 hours 1.
- Formoterol is also administered via a DPI or single-use capsule at a dose of 12 mcg every 12 hours 1.
- Both medications can cause tachycardia, skeletal muscle tremor, and hypokalemia, and should not be used for acute symptom relief or exacerbations 1.
Clinical Use of LABAs
- LABAs are not to be used as monotherapy for long-term control of asthma, due to potential safety concerns 1.
- They are preferred adjunctive therapy to combine with ICSs in youths 12 years of age and adults 1.
- Regular use of LABAs may lead to a decreased duration of protection against exercise-induced bronchospasm (EIB) 1.
- The safety of LABAs has been a topic of discussion, with potential risks of uncommon severe life-threatening or fatal exacerbations 1.
From the Research
Twice Daily Long-Acting Beta-Agonist (LABA) Inhalers for Asthma
- Twice-daily combination therapy of inhaled corticosteroids and long-acting beta2-adrenoceptor agonists (LABA) is a common treatment for moderate to severe asthma 2.
- Examples of twice-daily LABA inhalers include salmeterol and formoterol, which are often combined with inhaled corticosteroids such as fluticasone propionate (FP) 2, 3.
- The combination of LABA and inhaled corticosteroids has been shown to improve day-to-day control and reduce exacerbations compared to monotherapy with inhaled corticosteroids alone 2.
- Adjustable maintenance dosing with budesonide/formoterol may provide better control when compared to fixed-dosing combination regimens 2.
- Studies have also investigated the use of twice-daily LABA inhalers in combination with other therapies, such as slow-release theophylline and leukotriene inhibitors 2.
Comparison with Once-Daily Regimens
- Once-daily preparations, such as fluticasone furoate (FF) and vilanterol (VI), are also available and have been shown to be effective in improving asthma control 4, 5.
- A study comparing twice-daily FP-SAL with once-daily FF-VI found that patients using once-daily FF-VI were more likely to take their medication as prescribed 4.
- However, another study found that the evidence was insufficient to determine whether once-daily VI/FF was better or worse than twice-daily FP/SAL in terms of efficacy or safety 5.
Safety and Efficacy
- Long-acting beta-2 agonists (LABA) have been shown to be effective in controlling chronic asthma, but there are potential safety issues, particularly in those not taking inhaled corticosteroids 6.
- A study found that LABA treatment was associated with significant advantages in measurements of airway calibre, symptoms, and quality of life scores, but also with an increased risk of asthma-related deaths and life-threatening experiences 6.