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

Examples

Long-acting beta2-agonists:

Generic Name	Brand Name
formoterol	Foradil Aerolizer
salmeterol xinafoate	Serevent

Long-acting beta2-agonist and inhaled corticosteroid combinations:

Generic Name	Brand Name
budesonide and formoterol	Symbicort
fluticasone propionate and salmeterol	Advair Diskus, Advair HFA

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

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

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. For more information on how medications may be used together in asthma, see:

• Asthma medications for adults, teens, and children older than age 5.
• Asthma medications for children age 5 and younger.

How Well It Works

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

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 health professional right away.

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

What To Think About

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.

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Author:	Maria G. Essig, MS, ELS	Last Updated: May 15, 2007
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Harold S. Nelson, MD - Allergy and Immunology
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