Asthma and COPD Management with ICS/LABA Combinations

Introduction to ICS/LABA Combinations

The American College of Chest Physicians recommends against using combinations of ICS/LABA therapies, such as fluticasone/vilanterol and Advair HFA, due to therapeutic duplication and increased risk without additional benefit 1
Using both medications would result in excessive doses of both medication classes, including inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) 1

The use of ICS/LABA combinations is associated with increased risk of corticosteroid-related adverse effects, including adrenal suppression, increased risk of pneumonia, and potential for osteoporosis with long-term use 2
Additionally, there is an increased risk of LABA-related adverse effects, such as tachycardia, tremor, hypokalemia, and potential cardiovascular effects 2

Clinical trials have not demonstrated additional benefits of using multiple ICS/LABA combinations, and the American College of Chest Physicians guidelines do not support using combinations of these therapies 1
The American College of Chest Physicians recommends selecting either fluticasone/vilanterol or fluticasone/salmeterol based on dosing preference, individual response, insurance coverage, and device preference 3
ICS/LABA combinations are recommended for moderate to severe asthma not controlled with ICS alone, but they should never be used simultaneously 4

Medication reconciliation errors can occur when patients transition between healthcare providers, and brand/generic confusion can lead to prescribing errors 3
Failure to discontinue previous therapy can result in simultaneous use of two ICS/LABA combinations, which is potentially harmful 3
If a patient has been prescribed both medications, the prescriber should be contacted immediately to clarify which medication should be continued, and one of the medications should be discontinued 3