Long-acting beta-agonists role in asthma management.

The LABAs have played an important role in the management of asthma over the past decade. They are of clear benefit in reducing asthma-related symptoms and improving lung function when used in combination with an anti-inflammatory agent. Studies have shown, however, that their use has been associated with various negative outcomes, which has led to a restricted indication for salmeterol xinafoate (Serevent Diskus) and fluticasone propionate and salmeterol xinafoate (Advair Diskus), along with medication guides that will be given to patients with every new and refill prescription. Convincing data now exist that show an association of salmeterol with an increase in asthma-related deaths and life-threatening experiences, while formoterol is associated with more frequent serious asthma exacerbations. Nonetheless, LABAs remain an important component of asthma therapy. Further clarification about their role may occur with the release of additional analyses from SMART, as well as updated guidelines from the NAEPP Expert Panel, both expected later in 2006. In the meantime, LABAs and LABA-containing products are to be used only for patients not adequately controlled on other asthma-controller medications (eg, low- to medium-dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with 2 maintenance therapies. The NHLBI/NAEPP guidelines recommend inhaled corticosteroids as the first step in controller therapy, with LABAs as an option if low- to medium-dose inhaled corticosteroids do not adequately control the patient's asthma".