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AND THE ANSWERS ARE . . .

  1. Use of LABA along with inhaled corticosteroids (ICS) allows a significant reduction in the dose of ICS required to control moderate PA.
    True

  2. Salmeterol can be used effectively as rescue treatment of acute asthma episodes as well as long-term controller treatment.
    False

  3. Formoterol can be used effectively as rescue treatment of acute asthma episodes as well as long-term controller treatment
    True

  4. Expiratory airflow rates are gradually reduced during chronic treatment with LABA.
    False

  5. The bronchodilator effect of inhaled albuterol (a short acting beta agonist) is frequently reduced in asthmatics treated chronically with LABA.
    True

Discussion
Several studies have shown that concomitant use of LABA in moderate PA allows asthma control with about a 50% reduction in the moderate ICS dose needed for such control (1). In at least one study, addition of LABA to ICS doses of about 250 mcg/day lead to better control than increasing the ICS dose to 500 mcg/ day (reviewed in 2). Two inhaled LABA agents (Sal and Form) are currently used in the USA, both with a duration of significant bronchodilating effect of at least 8-12 hours hours. However, Sal is not recommended for rescue treatment because the onset of its bronchodilating effect is at about 30 minutes. In contrast, the onset of Form treatment is within a few minutes, as fast as that of albuterol (3,4). A recent study showed the efficacy of a Form-ICS combination as rescue as well as controller therapy (5).

Expiratory airflow function is not decreased in asthmatics treated chronically with LABA. However, the bronchodilating effect of albuterol may be decreased in such individuals. The clinical significance of the latter finding is uncertain. A recent study found that chronic use of short acting agonists, but not LABA, in the treatment of PA was a risk factor for asthma fatalities (6). However, in the SMART study, chronic use of Sal was associated with an increased frequency of asthma fatalities (although still at a very low frequency).

References
1. JAMA 2001;285:2594-2603
2. Curr Allergy and Asthma Rep 2005;5:123-9
3. Pediatr Allergy Immunol 2004;15:32-9
4. Allergol Immunopathol 2004;32:18-20
5. Am J Respir Crit Care Med 2005;171:95-97
6. BMJ 2005;33:117

 





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