Long-acting beta2 antagonists (LABAs)

Long acting beta2-agonists (LABAs) are not recommended as monotherapy for long-term control of persistent asthma, but should be continued adjunctive therapy to inhaled corticosteroids.

LABA is the most effective therapy for patients with severe persistent asthma or asthma not well controlled by inhaled corticosteroids.

Available long-acting β2 agonists include salmeterol, formoterol, bambuterol, and sustained-release oral salbutamol.

Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread – combination preparations include fluticasone/salmeterol and budesonide/formoterol.

Use of LABAs associated with a higher risk for catastrophic asthma events, including hospitalizations, intubations, and deaths.

The FDA recommends that once asthma control is achieved and maintained, patients should go to step down therapy to discontinue LABA treatment, if possible without loss of asthma control medication should continue with long-term medications such as inhaled corticosteroids.

A meta-analysis of discontinuing LABA therapy in the adults and older children with asthma control with combination of inhaled corticosteroids and long acting beta two agonists results in increased asthma associated impairment (Brozek JL et al).

Meta-analysis of 110 clinical trials of long-acting beta agonists involving 60,000 patients taking formoterol, salmeterol, formoterol plus budesonide, and salmeterol plus fluticasone: the long-acting beta agonists (LABA). were associated with a greater risk of asthma related death, asthma related intubation or asthma related hospitalization, 16 deaths occurred in the salmeterol group and only 4 deaths in the non-long acting beta agonist group (Rappley).

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