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 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.
LABAs include:
- Salmeterol (Serevent Diskus)
- Formoterol (Perforomist)
- Arformoterol (Brovana)
A LABA should be taken with an inhaled corticosteroid, such as:
- Fluticasone (Flovent HFA, Flovent Diskus)
- Budesonide (Pulmicort Flexhaler, Pulmicort Respules)
- Mometasone (Asmanex HFA)
- Flunisolide (Aerospan)
- Beclomethasone (Qvar)
Another option is to take a medication that combines both a corticosteroid and a LABA. There are four of these medications on the market:
- Fluticasone and salmeterol (Advair Diskus, Advair HFA)
- 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.
Aug. 12, 2017
- Lemanske RF. Beta agonists in asthma: Controversy regarding chronic use. http://www.uptodate.com/index. Accessed Jan. 22, 2017.
- Cates CJ, et al. Safety of regular formoterol or salmeterol in adults with asthma: An overview of Cochrane reviews. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010314.pub2/full. Accessed Jan. 22, 2017.
- 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 Jan. 27, 2017.
- AAAAI allergy and asthma medication guide. http://www.aaaai.org/conditions-and-treatments/treatments/drug-guide/inhaled-corticosteroids.aspx. Accessed Feb. 3, 2017.
- Horiuchi K, et al. Step-down therapy in well-controlled asthmatic patients using salmeterol xinafoate/fluticasone propionate combination therapy. Journal of Asthma and Allergy. 2016;9:65.