Contents

Search

long-acting beta adrenergic receptor agonist (LABA)

Indications: - prevention of bronchospasm in patients with COPD or asthma Benefit/risk: - number needed to treat (NNT) - adults* - 73 to prevent 1 moderate asthma attack requiring oral glucocorticoids [8] - number needed to harm - adults* - 140 to precipitate 1 severe asthma attack requiring hospitalization [8] - 1400 to precipitate 1 fatal asthma attack [8] - no benefit for children* - hospitalization not avoided - oral glucocorticoids not avoided [8] - no harms noted in children* [8] - no mortality benefit in patients with COPD [9] * in conjunction with inhaled glucocorticoid Contraindications: - not for use in treating asthma without an inhaled glucocorticoid Adverse effects: - when taken without an inhaled glucocorticoid, may or may not increase risk for death [4,5,6]* - Advair Diskus, Foradil Aerolizer, & Serevent Diskus may increase risk of severe asthma episodes, & death when those episodes occur [1,2], odds ratio=2.6-3.5 - increased cardiovascular risk in the elderly - highest risk 2-3 weeks after starting treatment [7] * risk for asthmatics > risk for patients with COPD * FDA has found no significant increase in risk of adverse outcomes when LABA used in combination inhaled glucocorticoid [10,11] * box warning removed Dec 2017 [10,11] Mechanism of action: - beta-2 adrenergic receptor agonists

Interactions

drug adverse effects of adrenergic receptor agonists

Specific

formoterol (Foradil, Perforomist) indacaterol (Arcapta) olodaterol (Striverdi Respimat) salmeterol (Serevent, Serevent Diskus) vilanterol

General

beta-adrenergic receptor agonist

References

  1. FDA Medwatch http://www.fda.gov/medwatch/safety/2005/safety05.htm#LABA
  2. Prescriber's Letter 12(9): 2005 The Safety of Long-Acting Beta-2 Agonists in Patients with Asthma Detail-Document#: 210907 (subscription needed) http://www.prescribersletter.com - US Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma-Update on selected topics 2002. http://www.nhlbi.nih.gov/guidelines/asthma/asthmafullrpt.pdf
  3. Salpeter SR et al, Meta-analysis: Effect of long-acting beta agonists on severe asthma exacerbations and asthma-related deaths. Ann Intern Med 2006; 144:904 PMID: 16754916 - Glassroth J The role of long-acting beta-agonists in the management of asthma. Analysis, meta-analysis, and more analysis, Ann Intern Med 2006; 144:936 PMID: 16754915
  4. FDA advisory panel meeting Joint Meeting of the Pulmonary-Allergy Drugs Advisory Committee, Drug Safety & Risk Management Advisory Committee, and the Pediatric Advisory Committee December 10 & 11, 2008 http://www.fda.gov/ohrms/dockets/ac/08/briefing/2008-4398b1-00-index.htm - Bateman E et al Effects of adding salmeterol to inhaled corticosteroids on serious asthma-related events. Ann Intern Med. 2008 Jul 1;149(1):33-42. Epub 2008 Jun 3. PMID: 18523132 http://www.annals.org/cgi/content/full/0000605-200807010-00229v1 - Weiss KB. Drug safety and salmeterol: The controversy continues. Ann Intern Med. 2008 Jul 1;149(1):56-7. Epub 2008 Jun 3. PMID: 18523131 http://www.annals.org/cgi/content/full/0000605-200807010-00230v1
  5. Prescriber's Letter 16(1): 2009 Safety of Long-Acting Beta-Agonists in Asthma Detail-Document#: 250102 (subscription needed) http://www.prescribersletter.com
  6. Prescriber's Letter 17(4): 2010 New Safety Requirements for Long-Acting Beta-Agonists (LABAs) COMMENTARY: New Safety Requirements for Long-Acting Beta-Agonists (LABAs) COMMENTARY: Childhood Asthma Treatment: The BADGER Study Detail-Document#: 260401 (subscription needed) http://www.prescribersletter.com
  7. Gershon A et al Cardiovascular Safety of Inhaled Long-Acting Bronchodilators in Individuals With Chronic Obstructive Pulmonary Disease. JAMA Intern Med. 2013;():1-9. PMID: 23689820 http://archinte.jamanetwork.com/article.aspx?articleid=1689974
  8. The NNT: Long-Acting Beta-Agonists with Inhaled Corticosteroids vs. Inhaled Steroids Alone for Adults with Asthma. http://www.thennt.com/nnt/combination-inhalers-steroids-plus-bronchodilators-for-adult-asthma/ - The NNT: Long-Acting Beta-Agonists with Inhaled Corticosteroids vs. Inhaled Steroids Alone for Children with Asthma. http://www.thennt.com/nnt/combined-inhalers-vs-steroid-inhalers-for-childhood-asthma/ - Ducharme FM, Ni Chroinin M, Greenstone I, Lasserson TJ. Addition of long-acting beta2-agonists to inhaled steroids versus higher dose inhaled steroids in adults and children with persistent asthma. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005533 PMID: 20393943
  9. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  10. Brooks M FDA Drops Boxed Warning on LABA/ICS Asthma/COPD Meds Medscape - Dec 21, 2017. https://www.medscape.com/viewarticle/890470 - FDA Safety Alert. Dec 20, 2017 Long-Acting Beta agonists (LABAs) and Inhaled Corticosteroids (ICS): Drug Safety Communication - Boxed Warning About Asthma- Related Death Removed. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm590001.htm
  11. Busse WW, Bateman ED, Caplan AL et al Combined Analysis of Asthma Safety Trials of Long-Acting beta2- Agonists. N Engl J Med 2018; 378:2497-2505. June 28, 2018 PMID: 29949492 https://www.nejm.org/doi/full/10.1056/NEJMoa1716868 - Seymour SM, Lim R, Xia C. Persepctive. Inhaled Corticosteroids and LABAs - Removal of the FDA's Boxed Warning. N Engl J Med 2018; 378:2461-2463. June 28, 2018 PMID: 29949485 https://www.nejm.org/doi/full/10.1056/NEJMp1716858

Component-of

LABA glucocorticoid combination LABA/LAMA combination LABA/LAMA glucocorticoid combination (triple therapy)