Long-acting beta2-agonists for long-term control of asthma

Examples

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Long-acting beta2-agonists:

Brand Name	Generic Name
Foradil Certihaler	formoterol

Brand Name	Generic Name
Serevent	salmeterol

Combinations of a long-acting beta2-agonist and inhaled corticosteroid:

Brand Name	Generic Name
Symbicort	budesonide and formoterol

Brand Name	Generic Name
Advair	fluticasone and salmeterol

These medications are used in a metered-dose or dry powder inhaler. Inhalers may be used differently, depending on the medication used. Always consult the directions to be sure you are using the inhaler correctly.

How It Works

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Long-acting beta2-agonists (bronchodilators) relax the smooth muscles lining the airways that carry air to the lungs (bronchial tubes), allowing the tubes to remain open longer and making breathing easier.

Salmeterol takes about 30 minutes to start to work, reaches peak effectiveness after 3 to 4 hours, and lasts for more than 12 hours.

Formoterol starts to work within a few minutes and also lasts for more than 12 hours.

Why It Is Used

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Long-acting inhaled beta2-agonists are used on a daily basis to control moderate and severe persistent asthma. The U.S. National Asthma Education and Prevention Program (NAEPP) recommends using them only as an addition to inhaled corticosteroids.¹ Long-acting inhaled beta2-agonists enhance the corticosteroids' anti-inflammatory action for controlling asthma and preventing asthma attacks. They should not be used as a substitute for inhaled corticosteroids.

Different types of medications are often used together in the treatment of asthma. Medication treatment for asthma depends on a person’s age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.

• Children up to age 4 are usually treated a little differently than those 5 to 11 years old.
• The least amount of medicine that controls the asthma symptoms is used.
• The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
• If the asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
• Quick-relief medicine is used to treat asthma attacks. But if you or your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.

Your doctor will work with you to help find the number and dose of medicines that work best.

How Well It Works

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A review of research reports that in adults with persistent asthma who use inhaled corticosteroids but continue to have symptoms (poorly controlled asthma), adding long-acting beta2-agonists:²

• Improved symptoms and lung function compared with using a corticosteroid only.
• Improved symptoms and lung function and resulted in less use of quick-relief medication compared with increasing the dose of inhaled corticosteroids.
• Improved lung function compared with adding a leukotriene pathway modifier.

A review of research reports that in children with persistent asthma who use inhaled corticosteroids but continue to have symptoms (poorly controlled asthma), adding long-acting beta2-agonists resulted in:³

• Improved lung function in the first few months of treatment but not after 1 year.
• More symptom-free days at 3 months.

Side Effects

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Side effects of long-acting beta2-agonists may include:

• Throat irritation and hoarseness (caused by inhaled corticosteroids in combination medications).
• Rapid heartbeat or palpitations.
• Headache and dizziness.
• Nausea, vomiting, and diarrhea.
• Anxiety.
• Nervousness or tremor (such as unsteady, shaky hands).

The U.S. Food and Drug Administration (FDA) has reported that these medicines may make an asthma episode worse and may increase the risk of death. If your wheezing gets worse after you take this medicine, call your doctor right away.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Long-acting inhaled beta2-agonists should not be used without being combined with an inhaled corticosteroid. Salmeterol may improve your symptoms at first. But if you stop taking an inhaled corticosteroid, the inflammation in the bronchial tubes will return, and your symptoms may become worse because of decreasing lung function and increasing inflammation.

When salmeterol is used to prevent asthma symptoms during exercise, it needs to be given at least 30 to 60 minutes before exercise.

Long-acting inhaled beta2-agonists, which are slower-acting medicines, should never be used in place of a short-acting beta2-agonist to treat asthma attacks. A quick-relief medication such as inhaled albuterol should be used.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. National Institutes of Health (2007). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08–5846). Available online: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.

2. Dennis RJ, et al. (2005). Asthma, search date May 2004. Online version of Clinical Evidence (14): 1847–1877.

3. Keeley D, McKean M (2006). Asthma and other wheezing disorders in children, search date October 2004. Online version of Clinical Evidence (15): 1–25.

Credits

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Author	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Harold S. Nelson, MD - Allergy and Immunology
Last Updated	May 15, 2007