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SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
12/22/06
Is there a preferred temporal sequence for inhaling beta agonists and corticosteroids?
Summary
Background – A combination of inhaled long-acting beta agonist (LABA) and corticosteroid (ICS) agents is used extensively in the treatment of persistent asthma (PA). Based mainly on theoretical considerations, it is commonly assumed that the LABA should be inhaled first, then the ICS in each treatment session.
Findings – Dal Negro et al of the Orlandi General Hospital in Verona, Italy compared the effects of LABA and ICS inhaled in each order. They found that in terms of both lung function and clinical outcomes, the efficacy of sequential LABA and ICS inhalation were similar regardless of which order these agents were inhaled. Similar efficacy was also seen when the ICS and LABA were inhaled at exactly the same time using a combination inhaler
Reference
Allergy Immunol 2006;38:153-7
Editor's Comments
I was one of those clinicians who “felt” that inhalation of a beta agonist right before the ICS was preferred because the beta agonist-induced bronchodilation would enhance penetration of the subsequently inhaled ICS to more peripheral lower airways. However, onset of bronchodilation induced by the LABA used in this study (salmeterol) was likely around 30 minutes, not soon enough to affect penetration by an ICS inhaled within 5 minutes after the salmeterol.
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