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LABA therapy in Asthma : What you need to know

asthma LABA therapy

LABAs dilates the airways and prevents bronchospasm but has no action on airway inflammation. Studies show it increases asthma related deaths. LABA should always be combined with inhaled corticosteroids (ICS) and should never be used as a 'solo' therapy.

LABA short hand for Long Acting Beta Agonist is one of the effective drugs used in the management of asthma.It forms the cornerstone of asthma therapy along with another class of drug inhaled corticosteroids (ICS). Most international guidelines recommend its use along with inhaled corticostreroids. The following are some of the salient points that asthmatics using LABA should know.

Salmeterol and Formoterol are the LABAs used extensively. LABA is a reliever medication and it acts by dilating the airways but doesn't have any anti inflammatory actions on the airway mucosa. Hence LABA should never be used as a monotherapy. It should always be accompanied by inhaled corticosteroids.

Newly diagnosed asthmatics should be first initiated on inhaled corticosteroids first. For patients not controlled on the initial ICS either the ICS dosage can be increased or LABA can be added.  Studies show adding LABA improves the symptom control and lung function. Some physicians introduce LABA later only if inhaled corticosteroids by itself is unable to contol the asthma symptoms. Though LABA may be used to reduce the dose of ICS, this practise should be avoided. This strategy increases the rate of exacerbations. Furthermore using LABA masks the underlying inflammation in the airway mucosa as LABA artificially prevents bronchospasm even though the underlying mucosa is inflammed.

LABA has been shown to increase asthma related deaths but combining with inhaled corticosteroids is helpful as ICS has been shown to provide protective effect. Hence use of LABA should be preferably avoided in children. In children with asthma not controlled on ICS, the first choice should be either increasing the dose of ICS or adding another class of drugs called as Leukotriene receptor antagonist.
Asthmatics generally prefer to use LABA/SABA (Short acting beta agonists) as they give rapid relief as opposed to inhaled corticosteroids which takes long time to act. But good compliance with inhaled corticosteroids is the best way to prevent future acute asthma exacerbations. When asthma comes under control, the LABA can be withdrawn and asthma can be managed solely with inhaled steroids.  

Wednesday, October 1, 2014