From the Guidelines
Long-acting beta-agonists (LABAs) combined with inhaled corticosteroids (ICS) are recommended for patients with persistent asthma not adequately controlled on ICS alone. This recommendation is based on the most recent and highest quality study available, which compared the effectiveness and safety of different maintenance strategies in preventing asthma exacerbations 1. The study found that combined inhaled corticosteroids and long-acting β-agonists were the most effective and safe strategy in preventing severe exacerbations of asthma.
Key Points to Consider
- Common LABA/ICS combinations include fluticasone/salmeterol (Advair), budesonide/formoterol (Symbicort), mometasone/formoterol (Dulera), and fluticasone/vilanterol (Breo Ellipta) 1.
- These combinations are typically prescribed as 1-2 inhalations twice daily (except Breo Ellipta, which is once daily).
- LABAs should never be used alone for asthma due to increased risk of severe exacerbations and death; they must always be combined with an ICS 1.
- The combination works synergistically—LABAs relax airway smooth muscle for bronchodilation while corticosteroids reduce inflammation.
- This dual approach provides better symptom control and reduces exacerbation risk compared to increasing the ICS dose alone.
Patient Instructions
- Patients should be instructed to rinse their mouth after use to prevent oral thrush.
- Patients should always have a rescue inhaler (like albuterol) available for breakthrough symptoms.
- Regular follow-up is essential to assess control and adjust therapy as needed 1.
From the FDA Drug Label
Use of LABA as monotherapy (without ICS) for asthma is associated with an increased risk of asthma-related death When LABA are used in fixed-dose combination with ICS, data from large clinical trials do not show a significant increase in the risk of serious asthma-related events (hospitalizations, intubations, death) compared with ICS alone
The use of a LABA (such as salmeterol) in combination with a steroid (such as fluticasone propionate) is a common treatment approach for asthma. The key points to consider are:
- LABA monotherapy is associated with an increased risk of asthma-related death.
- LABA/ICS combination does not show a significant increase in the risk of serious asthma-related events compared to ICS alone. Therefore, for asthma treatment, a LABA (such as salmeterol) should be used in combination with a steroid (such as fluticasone propionate) to minimize the risk of serious asthma-related events 2.
From the Research
LABA Steroid for Asthma
- The use of Long-Acting Beta Agonists (LABA) in combination with inhaled corticosteroids (ICS) is a common treatment approach for asthma, particularly for patients with moderate to severe asthma 3, 4, 5.
- Studies have shown that combination therapy using LABA and ICS in a single inhaler device confers complementary and synergistic effects in the management of asthma, improving patient compliance and reducing morbidity associated with the disease 3, 5.
- The combination of LABA and ICS has been found to be effective in reducing asthma exacerbations and improving lung function, with some studies suggesting that it may be more effective than using either medication alone 4, 5.
- Different combination inhalers are available, including budesonide/formoterol and salmeterol/fluticasone, which have been shown to be effective and well-tolerated in asthma treatment 5, 6.
- Recent guidelines recommend the use of ICS-LABA combination therapy for the long-term treatment of patients with moderate to severe asthma, as it achieves efficacy equivalent to or better than doubling the ICS dose and may improve patient adherence and reduce high-dose ICS-related adverse effects 7.
- The treatment approach for asthma should be individualized, taking into account the patient's specific needs and circumstances, and may involve the use of LABA and ICS in combination with other medications, such as leukotriene receptor antagonists or biologic therapies 7.