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FDA and Long Acting Bronchodilators

Hi. I came across this press release tinyurl.com/283hllp from the FDA in the states about Long Acting BD's. Basically they recommend that:

- The use of LABAs is contraindicated without the use of an asthma controller medication such as inhaled corticosteroid. Single-agent LABAs should only be used in combination with an asthma controller medication; they should not be used alone;

- LABAs should only be used long-term in patients whose asthma cannot be adequately controlled on asthma controller medications;

- LABAs should be used for the shortest duration of time required to achieve control of asthma symptoms and discontinued, if possible, once asthma control is achieved. Patients should then be maintained on an asthma controller medication.

- Pediatric and adolescent patients who require a LABA in addition to an inhaled corticosteroid should use a combination product containing both an inhaled corticosteroid and a LABA to ensure compliance with both medications.

It struck me from my own experience and reading some of the posts on here that GPs are rather quick to prescribe serevent/symbicort and the like and keep you on them. I've gone back to my steroid inhaler at a higher dose without an LABD (after a nasty time with symbicort) and feel ok with it.

What do other folks feel?

2 Replies

My asthma's been really well controlled since I started on serevent, and then switched to seretide. The nurse told me they'd rather we were on lower doses of steroids? Also LABA's are better for exercise induced asthma, according to her.

So I guess it's a case of, whatever suits the patient. In my case I had horrible jitters for about a fortnight then they settled down, and sometimes my hands shake, nut this is preferable to gagging on clenil, which never seemed to do the trick!


The guidelines do actually state that LABA's must not be prescribed without a steroid inhaler or equiv, but the point about being prescribed combination inhalers and then never trying to come off them isn't correct, once you've gained and retained control from a period of time, at least 3 months, then trying to reduce the dose of one or more components does become more difficult with combi-halers but if you've tried in the past and failed then trying again is rather pointless.

LABA's have very little clinical evidence to support their benefits for exercise induced asthma, but those who do suffer with EIA may benefit but the recommended and most effective is the addition of a leukotrine modifier , or the older but effective cromolyn and nedocromil.


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