Stopping long-acting beta2-agonists (LABA) for adults with asthma well-controlled on LABA and inhaled corticosteroids

Abstract

Stopping long-acting beta 2-agonists (LABA) for adults with asthma well controlled by LABA and inhaled corticosteroids (Review)

The US Food and Drug Administration’s drug safety recommendations and long-acting beta2-agonist dispensing pattern changes in adult asthma patients: 2003–2012

“…We do not know whether patients discontinued LABA because they had achieved good control over their asthma symptoms or for other reasons. For confirmation of appropriate step-down therapy, more granular clinical data (e.g., symptoms and pulmonary function and safety outcomes) and careful evaluation of long-term stability are needed;18–21 however, these data were not available in this current US claims database.…”

Why and how to step down chronic asthma drugs

“…27 Discontinuation of long acting bronchodilator was associated with reduced quality of life scores (odds ratio 0.36, 0.15 to 0.57) and asthma control questionnaire scores (0.24, 0.13 to 0.35). The clinical relevance of mean decreases of 0.36 and 0.24 in quality of life and asthma control scores, respectively, is less certain given that the minimal clinically important difference for these measures is 0.5.…”

“…39 The evidence supporting an increased risk of loss of asthma control following step-down from ICS-LABA to inhaled corticosteroid alone is based on systematic review of multiple trials. 27 Higher fixed dose ICS-LABA to lower dose ICS-LABA One approach to reduce overall inhaled corticosteroid use is to include inhaled corticosteroid with a fast acting LABA for on-demand use with a lower background maintenance dose. This strategy has been called single inhaler maintenance and reliever therapy (SMART) or single inhaler therapy (SiT).…”

Stepping down from combination asthma therapy: The predictors of outcome

“…However, prompted by reports about possible elevated mortality and an excess risk of asthma exacerbations with LABAs, the U.S. Food and Drug Administration (FDA) recommends cessation of LABAs first with subsequent ICS dose reduction [7]. Cessation of LABAs from combination therapy is reported to increase asthma symptoms and lead to a loss of asthma control [5,8]. Such fears may have hindered stepping down from combination therapy, possibly leading to overtreatment of asthma with LABAs [2,3].…”

“…A better knowledge about how to identify subjects who would tolerate medication reduction might encourage physicians to start reductions more often than previously. It has been widely acknowledged that more studies are needed to determine the predictors of outcome especially when LABAs are discontinued first from combination therapy [6,8,9].…”