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Asthma inhalers: Are long-acting beta-2 agonists (LABAs) safe?
Asthma inhaler medications called long-acting beta-2 agonists (LABAs) have been linked to dangerous asthma attacks — but these medications can be an effective treatment when used properly.
By Mayo Clinic staffYou may have heard about it on the news or noticed a warning on your asthma inhaler medication. Specific asthma inhalers called long-acting beta-2 agonists (LABAs) — such as Serevent, Advair or Foradil — may increase your risk of a life-threatening asthma attack. These medications are delivered via a dry powder inhaler or an aerosol inhaler and are used for long-term treatment of moderate and severe asthma.
You're not alone if you are concerned about the possible dangers of these asthma inhalers — and you may even wonder if you should stop using them. But don't change anything until you talk to your doctor. Even though LABAs have been linked to dangerous asthma attacks in some people, they're still an important treatment option for many people with moderate or severe asthma. When used correctly — combined with inhaled corticosteroids and monitored carefully — long-acting beta-2 agonist asthma inhalers reduce symptoms and are less likely to cause a dangerous reaction.
What are long-acting beta-2 agonists?
Long-acting beta-2 agonists (LABAs) are part of a group of asthma inhalers called bronchodilators. Used along with inhaled corticosteroids, LABAs reduce asthma symptoms and lessen the need for short-term "rescue" medication. They open up constricted airways for 12 hours or longer and are used to control moderate and severe asthma and to prevent nighttime symptoms. LABAs used to treat asthma include:
- Serevent Diskus. This medication contains the LABA salmeterol, administered with a disk-shaped inhaler device.
- Advair Diskus. This medication combines the LABA salmeterol and the inhaled corticosteroid fluticasone. Like Serevent, it's also delivered with a disk-shaped device.
- Foradil Aerolizer. This medication contains the LABA formoterol.
- Symbicort. This medication combines the LABA formoterol and the inhaled corticosteroid budesonide.
Why the concern?
A large recent study of salmeterol (Serevent) showed that people taking the medication, especially blacks, were at a higher risk of life-threatening asthma attacks or death than were people taking a placebo. The Salmeterol Multi-Center Research Trial (SMART), designed to test the safety of Serevent, had about 26,000 participants. It was stopped early because of safety concerns.
As a result of the study, the Food and Drug Administration (FDA) issued a public health advisory for LABA medications in 2005. It warns that these medications can cause a "small but significant risk in asthma-related deaths." The FDA also required the addition of new "black box" safety labels to these medications.
The warnings about LABas come at a time of heightened public concern about potentially dangerous drugs. Recently, problems with selective cyclooxygenase inhibitors (selective COX-2 inhibitors) led to the withdrawal of the pain medication Vioxx from the market because of dangerous side effects. But unlike with selective COX-2 inhibitors, the dangers of long-acting beta-2 agonists aren't so clear-cut.
Concerns over the risks of beta agonists aren't new. Since the 1970s, several studies have shown that short-acting beta agonists may increase the risk of serious or fatal asthma attacks in some people. But experts contend that severe reactions may be at least partly caused by the fact that in many studies, LABAs weren't always used in conjunction with inhaled corticosteroids or in the context of good medical care. When they're used correctly, the benefits of using LABAs appear to outweigh the possible risks for many people with moderate or severe asthma.
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