Long-acting beta2-agonists for long-term control of asthma

Examples

Combinations of a long-acting beta2-agonist and inhaled corticosteroid:

Generic Name	Brand Name
formoterol and budesonide	Symbicort
salmeterol and fluticasone	Advair

Long-acting beta2-agonists are used only in combination with a corticosteroid to treat asthma. They are used in a metered-dose or dry powder inhaler. Inhalers may be used differently, depending on the medicine used. Always consult the directions to be sure you are using the inhaler correctly.

How It Works

Long-acting beta2-agonists (bronchodilators) relax the smooth muscles lining the airways that carry air to the lungs (bronchial tubes), allowing the tubes to remain open longer and making breathing easier.

Salmeterol takes about 30 minutes to start to work, reaches peak effectiveness after 3 to 4 hours, and lasts for more than 12 hours.

Formoterol starts to work within a few minutes and also lasts for more than 12 hours.

Why It Is Used

Long-acting inhaled beta2-agonists are used on a daily basis to control moderate and severe persistent asthma. The U.S. National Asthma Education and Prevention Program (NAEPP) recommends using them only as an addition to inhaled corticosteroids.¹ Long-acting inhaled beta2-agonists enhance the corticosteroids' anti-inflammatory action for controlling asthma and preventing asthma attacks. They should not be used as a substitute for inhaled corticosteroids.

Different types of medicines are often used together in the treatment of asthma. Medicine treatment for asthma depends on a person’s age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.

• Children up to age 4 are usually treated a little differently than those 5 to 11 years old.
• The least amount of medicine that controls the asthma symptoms is used.
• The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
• If the asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
• Quick-relief medicine is used to treat asthma attacks. But if you or your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.

Your doctor will work with you to help find the number and dose of medicines that work best.

How Well It Works

A review of research reports that in adults with persistent asthma who use inhaled corticosteroids but continue to have symptoms (poorly controlled asthma), adding long-acting beta2-agonists:²

• Improved symptoms and lung function compared with using a corticosteroid only.
• Improved symptoms and lung function and resulted in less use of quick-relief medicine compared with increasing the dose of inhaled corticosteroids.
• Improved lung function compared with adding a leukotriene pathway modifier.

A review of research reports that in children with persistent asthma who use inhaled corticosteroids but continue to have symptoms (poorly controlled asthma), adding long-acting beta2-agonists resulted in:³

• Improved lung function in the first few months of treatment but not after 1 year.
• More symptom-free days at 3 months.

Side Effects

Side effects of long-acting beta2-agonists may include:

• Throat irritation and hoarseness (caused by inhaled corticosteroids in combination medicines).
• Rapid heartbeat or palpitations.
• Headache and dizziness.
• Nausea, vomiting, and diarrhea.
• Anxiety.
• Nervousness or tremor (such as unsteady, shaky hands).

The U.S. Food and Drug Administration (FDA) has reported that these medicines may make an asthma episode worse and may increase the risk of death. If your wheezing gets worse after you take this medicine, call your doctor right away.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Long-acting inhaled beta2-agonists should not be used without being combined with an inhaled corticosteroid. If you don't take an inhaled corticosteroid, the inflammation in the bronchial tubes may not be controlled, and your symptoms could get worse because of decreasing lung function and increasing inflammation.

Long-acting inhaled beta2-agonists should never be used in place of a short-acting beta2-agonist to treat asthma attacks. A quick-relief medicine such as inhaled albuterol should be used.

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Author:	Maria G. Essig, MS, ELS	Last Updated: April 21, 2009
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Harold S. Nelson, MD - Allergy and Immunology
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