LABA monotherapy in asthma: an avoidable problem

Abstract

Long-acting beta 2-agonists (LABAs) (or beta-adrenoceptor agonists) improve lung function and quality of life, and are recommended at step 3 of the national guidelines for the management of asthma.1 However, chronic exposure to LABAs can be associated with tolerance and reduced sensitivity to the bronchodilator effects of salbutamol raising concerns over their use in asthma.2 In 2006 a large randomised trial called SMART (Salmeterol Multi-Centre Asthma Research Trial) involving 26 355 patients randomised to either inhaled salmeterol or placebo in addition to their usual care was reported.3 This trial found that significantly more serious adverse events and asthma-related deaths occurred in the salmeterol group. This risk was potentially confined to patients treated with LABA monotherapy only, as regular use of inhaled corticosteroids (ICS) was limited. A review of available data by the Medicines and Healthcare products Regulatory Agency (MHRA) concluded that the benefits of LABA/ICS combination therapy outweigh any potential risks in asthma.4 For this reason, LABAs are currently recommended for the management of asthma in combination with an ICS only. In 2009 the British Thoracic Society/Scottish Intercollegiate Guideline Network (BTS/SIGN) national asthma guidelines recommended prescribing LABAs either as separate inhalers or in combination inhalers with ICS.5 However, in 2011 BTS/SIGN revised their guidelines …