I've heard that long-acting beta agonists (LABAs) can cause severe asthma attacks. Should I stop taking them?
Answer 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 a LABA with an inhaled corticosteroid is appropriate treatment for many people who have asthma. Don't stop any of your asthma medications before checking with your doctor.
LABAs are used on a regular schedule to open narrowed airways and prevent asthma attacks. But because they may 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 for asthma. So if you're taking a LABA without an inhaled corticosteroid for asthma, check with your doctor.
LABAs include:
- Salmeterol (Serevent Diskus)
- Formoterol (Perforomist)
A LABA should be taken with an inhaled corticosteroid, such as:
- Fluticasone (Flovent)
- Budesonide (Pulmicort Flexhaler)
- Mometasone (Asmanex)
- Flunisolide
- Beclomethasone (Qvar)
- Ciclesonide (Alvesco)
If your doctor recommends a LABA and an inhaled corticosteroid for asthma, most likely you will use a single inhaler that combines both a corticosteroid and a LABA. There are four of these medications on the market:
- Fluticasone and salmeterol (Advair Diskus, Wixela Inhub, others)
- Budesonide and formoterol (Symbicort)
- Mometasone and formoterol (Dulera)
- Fluticasone and vilanterol (Breo Ellipta)
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.
Dec. 31, 2019
- Lemanske RF. Beta agonists in asthma: Controversy regarding chronic use. https://www.uptodate.com/search/contents. Accessed Dec. 6, 2019.
- Fanta CH. Treatment of intermittent and mild persistent asthma in adolescents and adults. https://www.uptodate.com/search/contents. Accessed Dec. 6, 2019.
- FDA drug safety communication: FDA review finds no significant increase in risk of serious asthma outcomes with long-acting beta-agonists (LABAs) used in combination with inhaled corticosteroids (ICS). U.S. Food and Drug Administration. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-review-finds-no-significant-increase-risk-serious-asthma-outcomes. Accessed Dec. 6, 2019.
- AAAAI allergy and asthma medication guide. https://www.aaaai.org/conditions-and-treatments/drug-guide/long-acting-bronchodilators-(labas). Accessed Dec. 4, 2019.
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- Li JT (expert opinion). Mayo Clinic. Dec. 13, 2019.