Long-acting beta-agonists and inhaled corticosteroids: A match made in heaven or hell?
Published Online: Janaury 27, 2012
Since the early 1990s, long-acting beta-agonists (LABAs) have been used either alone or in combination with inhaled corticosteroids (ICSs) to achieve asthma control. However, recent studies suggest that use of LABAs may increase the risk of severe asthma attacks and possibly asthma-related deaths. Moreover, this risk may be even greater in certain groups such as African American individuals with asthma. In response to these findings, the Food and Drug Administration recommended that LABA medication be used only in combined with an ICS medication. However, it is still unclear whether these combination preparations are safe or harmful, particularly in high-risk groups.
The article by Wells et al. in a recent issue of The Journal of Allergy & Clinical Immunology (JACI), examined whether individuals using a LABA in fixed-dose combination with an ICS have an increased or decreased risk for a severe asthma attack (defined needing rescue oral corticosteroid therapy, having an asthma-related emergency department visit, or requiring hospitalization) when compared to individuals on ICS therapy alone. Their study used longitudinal data on patients from a large healthcare system that serves a racially diverse urban and suburban population residing in the Midwest.
The researchers analyzed the likelihood of having a severe asthma exacerbation between individuals using LABA in combination with ICS as compared with ICS therapy alone. The data spanned eight years and included individuals aged 12 to 56 years at the time of their index medication fill. Detailed electronic records were available for health care visits and medication fills both within and outside of the health system, allowing the researchers to identify serious asthma-related events and estimate actual medication use, respectively. The data also included demographic information, such as race-ethnicity.
As compared with ICS treatment alone, use of LABA medication in fixed-dose combination with an ICS was associated with an as good as or better reduction in severe asthma exacerbations. Equally important, the results suggested that African American patients experienced similar beneficial effects by using fixed-dose ICS/LABA combination therapy. The authors are careful to point out that larger studies are needed to determine whether ICS/LABA combination therapy is associated with an increase or decrease in rarer asthma-related events, such as intubations and death. Nevertheless, the authors’ findings provide important interim evidence suggesting that ICS/LABA combination therapy is broadly effective in reducing severe asthma exacerbations in most risk groups.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.