Alarms about Asthma Agents
(or, LABAs Relabeled)
Long acting beta agonists (LABAs) are a family of inhaled medicines used to control asthma symptoms. LABAs include the medicines in Serevent and Foradil. LABAs are also available in combination inhalers, Advair and Symbicort, which combine a LABA with an inhaled steroid.
Though LABAs dilate airways and improve airflow, they have long been associated with an increased risk of worsening asthma symptoms. It has previously been thought that using an inhaled steroid with a LABA eliminated that risk, but until this is proven definitively the FDA took action to strengthen its warnings about LABAs.
In an announcement published yesterday (see link below), the FDA stressed that LABAs should never be used alone, and should only be used with an inhaled steroid. This much is not new and had been recommended in the past. (See my post about LABAs a year ago, link below.) The FDA also recommended that even when used in combination with inhaled steroids, LABAs should only be used for the minimum duration necessary to control symptoms, and then if possible should be discontinued. Only patients whose symptoms cannot be controlled on an inhaled steroid or other asthma controlling medication should be treated with a LABA for extended periods.
So if you’re using one of the above inhalers, a conversation with your doctor is in order. Obviously, don’t stop any of your asthma medicines without your doctor’s advice.
Finally, my regular readers know that I’m a big fan of electronic medical records. This is a perfect example of an instance in which electronic records extend patient care in a way that is impossible with paper charts. My partners and I will generate a report listing all our patients on LABAs so we can contact them to discuss whether a change is appropriate. With paper charts we would have just hoped that our patients heard the FDA warning and called us.