Long-Acting Beta2-Agonists for Long-Term Control of Asthma
Combinations of a long-acting beta2-agonist and inhaled corticosteroid:
|Generic Name||Brand Name|
|formoterol and budesonide||Symbicort|
|formoterol and mometasone||Dulera|
|salmeterol and fluticasone||Advair|
Long-acting beta2-agonists are used only in combination with a corticosteroid to treat asthma. They are used in a metered-dose or dry powder inhaler. Always read the directions to be sure you are using the inhaler correctly.
How It Works
Long-acting beta2-agonists (bronchodilators) relax the smooth muscles lining the airways that carry air to the lungs (bronchial tubes). This allows the tubes to stay open longer and makes breathing easier.
Salmeterol takes about 30 minutes to start to work. It reaches peak effectiveness after 3 to 4 hours and lasts for more than 12 hours.
Formoterol starts to work within a few minutes. It lasts for more than 12 hours.
Why It Is Used
Long-acting inhaled beta2-agonists are used on a daily basis to control moderate and severe persistent asthma. The U.S. National Asthma Education and Prevention Program (NAEPP) recommends using them only as an addition to inhaled corticosteroids.1 Long-acting inhaled beta2-agonists enhance the corticosteroids' anti-inflammatory action for controlling asthma and preventing asthma attacks. They should not be used as a substitute for inhaled corticosteroids.
Different types of medicines are often used together in the treatment of asthma. Medicine treatment for asthma depends on a person's age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.
- Children up to age 4 are usually treated a little differently than those 5 to 11 years old.
- The least amount of medicine that controls the asthma symptoms is used.
- The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
- If the asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
- Quick-relief medicine is used to treat asthma attacks. But if you or your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.
Your doctor will work with you to help find the number and dose of medicines that work best.
How Well It Works
A review of research found that in adults with persistent asthma who use inhaled corticosteroids but continue to have symptoms (poorly controlled asthma), adding long-acting beta2-agonists:2
- Improved symptoms and lung function compared with using a corticosteroid only.
- Improved symptoms and lung function and resulted in less use of quick-relief medicine compared with increasing the dose of inhaled corticosteroids.
- Improved lung function compared with adding a leukotriene pathway modifier.
A review of research found that in children with persistent asthma who use inhaled corticosteroids but continue to have symptoms (poorly controlled asthma), adding long-acting beta2-agonists resulted in:3
- Improved lung function as measured by forced expiratory volume at 1 minute (FEV1).
- More days free of symptoms (in children 4 to 16 years old).
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Common side effects of this medicine include:
- Throat irritation and hoarseness (caused by inhaled corticosteroids in combination medicines).
- Rapid heartbeat or palpitations.
- Headache and dizziness.
- Nausea, vomiting, and diarrhea.
- Nervousness or tremor (such as unsteady, shaky hands).
The U.S. Food and Drug Administration (FDA) has reported that these medicines may make an asthma episode worse and may increase the risk of death. If your wheezing gets worse after you take this medicine, call your doctor right away.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Long-acting inhaled beta2-agonists should not be used without being combined with an inhaled corticosteroid. If you don't take an inhaled corticosteroid, the inflammation in the bronchial tubes may not be controlled, and your symptoms could get worse because of decreasing lung function and increasing inflammation.
Long-acting inhaled beta2-agonists should never be used in place of a short-acting beta2-agonist to treat asthma attacks. A quick-relief medicine such as inhaled albuterol should be used.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- National Institutes of Health (2007). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08–5846). Available online: http://www.nhlbi.nih.gov/guidelines/asthma/index.htm.
- Dennis RJ, Solarte I (2011). Asthma in adults (chronic), search date April 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
- Turner ST, et al. (2012). Asthma and other recurrent wheezing disorders in children (chronic), search date June 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Last Revised: February 22, 2013
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