Examples of LABA Inhalers
Long-Acting Beta-Agonist (LABA) inhalers include salmeterol, formoterol, indacaterol, olodaterol, and vilanterol, which provide bronchodilation for at least 12 hours and are used for maintenance treatment of asthma (always with inhaled corticosteroids) and COPD. 1, 2
Standard 12-Hour LABAs
Salmeterol (Serevent) is a twice-daily LABA with duration of action exceeding 12 hours, highly specific for β2-adrenergic receptors with low rates of tremor and palpitations 1
Formoterol (Foradil) is a twice-daily LABA similar to salmeterol with duration exceeding 12 hours, but has a rapid onset of action within minutes, making it suitable for SMART (Single Maintenance And Reliever Therapy) regimens 1, 3
Ultra-LABAs (24-Hour Duration)
Indacaterol is a once-daily LABA approved for COPD treatment with 24-hour duration of action 2, 4
Olodaterol (Striverdi Respimat) is a once-daily LABA indicated for long-term maintenance bronchodilator treatment of COPD, delivering 2.5 mcg per actuation with two actuations constituting one dose 5, 2
Vilanterol is an ultra-LABA in development with 24-hour duration suitable for once-daily administration 2, 4
Common LABA Combination Products
Budesonide/formoterol (Symbicort) combines an ICS with formoterol at standard dosing of 160/4.5 mcg, two inhalations twice daily for moderate to severe asthma 3, 6
Salmeterol/fluticasone propionate (Seretide/Advair) is a fixed-dose ICS/LABA combination available for asthma and COPD management 6, 7
Fluticasone/formoterol is another ICS/LABA combination that provides faster onset of bronchodilation compared to salmeterol-containing products 8
Beclomethasone/formoterol represents an additional ICS/LABA combination option for COPD treatment 4
Critical Safety Considerations
LABAs must NEVER be used as monotherapy for asthma due to increased risk of serious asthma-related events including hospitalization and death, as mandated by FDA black-box warning 1, 3, 9
LABAs should always be prescribed in combination with inhaled corticosteroids for asthma management 1, 2
In COPD, LABAs can be used without ICS and improve lung function, reduce exacerbation frequency, and improve quality of life 10, 2
Distinguishing Features Between LABAs
Formoterol has rapid onset of action (within minutes) similar to short-acting beta-agonists, while salmeterol has slower onset and should not be used for acute symptom relief 3
Ultra-LABAs (indacaterol, olodaterol, vilanterol) allow once-daily dosing compared to twice-daily dosing required for salmeterol and formoterol 2, 4
LABA/LAMA combinations are being developed for COPD and appear to increase lung function more than LAMA alone 2