Examples of ICS/LABA Combination Inhalers
The two primary ICS/LABA combinations available are salmeterol/fluticasone (Advair/Seretide) and formoterol/budesonide (Symbicort). 1
Specific ICS/LABA Products
Salmeterol/Fluticasone Combinations
- Salmeterol/fluticasone is administered as a fixed-dose combination inhaled twice daily for maintenance therapy of moderate to severe persistent asthma 1, 2
- Available formulations include both dry powder inhalers (DPI) and hydrofluoroalkane (HFA) pressurized metered-dose inhalers (pMDI) 1
- This combination provides anti-inflammatory effects from fluticasone and bronchodilation from salmeterol with at least 12 hours duration of action 1
Formoterol/Budesonide Combinations
- Formoterol/budesonide (Symbicort) is administered twice daily as a fixed-dose combination for maintenance therapy 1
- Standard dosing for moderate to severe asthma in adults and children ≥12 years is budesonide/formoterol 160/4.5 mcg, two inhalations twice daily 3
- Available in multiple strengths with HFA-propelled MDI and DPI formulations 1
- Formoterol has a rapid onset of action (within minutes) unlike salmeterol, making it suitable for both maintenance and reliever therapy (SMART regimen) 3
Additional ICS/LABA Options
- Fluticasone propionate/formoterol fumarate is also commercially available in Europe for asthma maintenance therapy 4
- Beclometasone dipropionate/formoterol fumarate represents another fixed-dose combination option 5, 4
- Mometasone furoate is available as an ICS component in combination products administered by DPI 1
Critical Safety Considerations
- LABAs must NEVER be used as monotherapy for asthma control due to increased risk of asthma-related deaths, hospitalizations, and intubations 2
- The FDA has issued a black-box warning against LABA monotherapy; these agents must always be prescribed in fixed-dose combination with an inhaled corticosteroid 1, 3
- When LABAs are used in fixed-dose combination with ICS, large clinical trials do not show a significant increase in the risk of serious asthma-related events compared with ICS alone 2
Comparative Efficacy
- Both salmeterol/fluticasone and formoterol/budesonide combination therapies demonstrate greater improvements in lung function, symptom control, and exacerbation reduction compared to their individual monocomponents 6, 7
- In children aged 6-11 years with persistent asthma, ICS-LABA fixed-dose combinations are more effective than ICS monotherapy in preventing exacerbations requiring systemic corticosteroids 8
- Budesonide/formoterol reduces the risk of hospitalizations/emergency room visits by 28-37% compared to salmeterol/fluticasone in some studies 5