I've heard that long-acting beta agonists (LABAs) can cause severe asthma attacks. Should I stop taking them?
Answers from James T C Li, M.D., Ph.D.
In some studies, long-acting beta agonists (LABAs) have been linked to life-threatening asthma attacks. The risk appears to be greatest when a LABA is used without also using an inhaled corticosteroid. In contrast, taking an inhaled corticosteroid along with a LABA is appropriate treatment for many people who have asthma. Don't stop any of your asthma medications before checking with your doctor first.
LABAs are used on a regular schedule to open up narrowed airways and prevent asthma attacks. But because they increase the risk of having a life-threatening asthma attack, the Food and Drug Administration warns that LABAs should never be used without an inhaled corticosteroid. So if you're taking a LABA without an inhaled corticosteroid, check with your doctor.
- Salmeterol (Serevent)
- Formoterol (Foradil, Perforomist)
- Arformoterol (Brovana)
A LABA should be taken with an inhaled corticosteroid, such as:
- Fluticasone (Flonase, Flovent HFA)
- Budesonide (Pulmicort Flexhaler, Pulmicort Respules, Rhinocort)
- Mometasone (Asmanex)
- Flunisolide (Aerobid, Aerospan)
- Beclomethasone (Qvar, Qnasl)
One option is to take a single medication that combines both a LABA and a corticosteroid. There are three of these medications on the market:
- Salmeterol and fluticasone (Advair)
- Formoterol and budesonide (Symbicort)
- Formoterol and mometasone (Dulera)
Children who need both a LABA and a corticosteroid should take them only as a combination medication, and not as separate medications.
The benefits of LABAs to keep asthma under control generally outweigh the risks — if they're used as recommended. If you have any questions about your asthma medications, talk to your doctor. To be safe:
- Confirm with your doctor that you know how to take your medications. If you don't take LABAs or other asthma medications exactly as prescribed, you may be increasing your risk of an asthma attack. Always talk to your doctor before making medication changes or stopping a medication.
- Keep a quick-relief (rescue) inhaler on hand. LABAs don't treat sudden (acute) asthma symptoms. An albuterol inhaler or other quick-relief inhaler can prevent an asthma flare-up from becoming a severe asthma attack.
- Meet with your doctor on a regular basis. Asthma symptoms change over time, so the medications you need may change as well. If your asthma can be controlled without a LABA, your doctor may recommend that you stop using one.
- Talk to your doctor if your asthma isn't under control. The frequent need to use a quick-relief inhaler is a common sign of poorly controlled asthma. Talk to your doctor about other signs that your asthma may not be under control — and what to do if it isn't.
LABAs are sometimes used to treat chronic obstructive pulmonary disease (COPD). When used for COPD, LABAs don't have the same risks that are associated with asthma, so these warnings and recommendations don't apply.
Dec. 19, 2012
- Lemanske RF. Beta agonists in asthma: Controversy regarding chronic use. http://www.uptodate.com/index. Accessed Sept. 20, 2012.
- Morales DR, et al. Long-acting beta-agonist prescribing in people with asthma in primary care. Thorax. In press. Accessed Sep 20, 2012.
- FDA drug safety communication: Drug labels now contain updated recommendations on the appropriate use of long-acting inhaled asthma medications called long-acting beta-agonists (LABAs). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213836.htm. Accessed Sept. 20, 2012.
- AAAAI allergy and asthma medication guide. http://www.aaaai.org/conditions-and-treatments/treatments/drug-guide/inhaled-corticosteroids.aspx. Accessed Oct. 9, 2012.
- Brozek JL, et al. Long-acting beta-agonist step-off in patients with controlled asthma. Archives of Internal Medicine. In press. Accessed Sep. 27, 2012.