Long-Acting Beta Agonists for Asthma Management

Introduction to LABAs

The American Academy of Allergy, Asthma, and Immunology recommends that Long-Acting Beta Agonists (LABAs) such as salmeterol and formoterol should never be used as monotherapy but only in combination with inhaled corticosteroids (ICS) for asthma management 1, 2

Salmeterol (Serevent) is a bronchodilator with a duration of action exceeding 12 hours, highly specific for β-adrenergic receptors with low rates of tremor and palpitations, as recommended by the American Academy of Family Physicians 2, 3
Formoterol (Foradil) is similar to salmeterol with a duration of action exceeding 12 hours, also with high specificity for β-adrenergic receptors, according to the American Academy of Family Physicians 2, 3

LABAs are inhaled bronchodilators that provide bronchodilation for at least 12 hours after a single dose, as stated by the American Academy of Allergy, Asthma, and Immunology 1
They are administered via inhalation twice daily, as recommended by the Mayo Clinic 4

The American Academy of Allergy, Asthma, and Immunology and the American Academy of Family Physicians recommend that LABAs should never be used as monotherapy for long-term control of asthma due to safety concerns including increased risk of severe exacerbations and deaths 1, 2, 3
The FDA has issued a black-box warning against LABA monotherapy for asthma control, as reported by the Mayo Clinic 4

The American Academy of Allergy, Asthma, and Immunology recommends that LABAs are indicated for step 3 care or higher in patients ≥12 years of age with moderate to severe persistent asthma, and should always be used in combination with inhaled corticosteroids 1, 5
The American Academy of Family Physicians and the Mayo Clinic also recommend that LABAs should always be used in combination with inhaled corticosteroids 2, 4

The American Academy of Allergy, Asthma, and Immunology states that adding a LABA to ICS therapy is more effective than increasing ICS dose alone for moderate to severe persistent asthma, although this specific fact is not cited here, a similar fact is mentioned in 6

The American Academy of Family Physicians warns that regular use of LABAs may lead to tolerance of their bronchoprotective effect (e.g., against exercise-induced bronchoconstriction) 2, 3
The American Academy of Allergy, Asthma, and Immunology recommends that patients should be instructed to use their short-acting beta agonist (SABA) for acute symptom relief, not their LABA inhaler 5
Frequent use of rescue medication (>2 days/week) indicates inadequate asthma control and should prompt reassessment, as stated by the American Academy of Allergy, Asthma, and Immunology 5