Louise asked
I have had adverse reactions to two LABA medications. Advair and BREO. Shortness of breath, respiratory distress and worsening asthma. My doctor wants to try more LABA medications. I am very afraid to do this due to the black box warnings. Should I take the risk?
Answer
There has been considerably controversy regarding the safety of LABA (Long Acting Beta Agonist) medications. LABAs work by relaxing the muscles in the airways, easing inflammation and making respiration easier. LABA medications include:
- Serevent (Salmeterol)
- Foradil (Formoterol)
They work in a similar manner to the more common SABA (Short Acting Beta Agonst) medications like Albuterol (e.g. Proair, Ventolin). However, while SABA medications work quickly and last only a few hours, LABA medications generally last for more than 12 hours.
Safety Of LABA Medications
A 2006 study quickly turned the tide against the use of LABA medications. While we won't get into the specifics of the study, it produced results that showed the use of LABAs alone (as the sole therapy) were associated with an increased risk of asthma-related death and hospitalization from asthma exacerbation. The exact reasoning for this hasn't been determined but it is thought that the use of LABA medication, without the use of a controlling inhaled corticosteroid, masks the symptoms of underlying or worsening inflammation and leaves it untreated.
Partly due to the results from the above study, the FDA created a black box warning for "asthma related death" for all medications containing a LABA.
Recent data and studies have shown however, that LABA medications can play an important role in treatment of asthma and shouldn't be disregarded. In fact, they are considered safe and beneficial, but only when used in conjunction with inhaled corticosteroids. When used with steroids, they are not associated with increased death or hospitalizations and can improve asthma related symptoms.
Due to the new information regarding LABA medications and their role in therapy, the FDA removed the black box warning on medications that combine a LABA and an inhaled corticosteroid.
The use of a LABA medication in your situation will be up to you and your doctor. If you are concerned about a true drug allergy, hopefully your doctor can find a medication that you won't have a reaction to. Do know however, that you shouldn't be as concerned regarding LABA medications in terms of side effects, as long as they are in combination with an inhaled steroid. LABA/steroid combination medications include:
- Advair (Fluticasone/salmeterol)
- Symbicort (Budesonide/formoterol)
- Dulera (Mometasone/formoterol)
- Breo (Fluticasone furoate/vilanterol)
