What patients need to know about LABAs

The following was originally published on healthcentral.com/asthma on May 18, 2015.

Understanding Long Acting Beta Adrenergics (LABAs)

One of the best medicines for helping people with asthma breathe better are Long Acting Beta Agonists (LABAs). So what are LABAs, and how do they help you?

Asthma is a disease where exposure to asthma triggers causes the smooth muscles (bronchial muscles) wrapped around airways to spasm and contract. This causes airways to become narrow, thus making breathing difficult.

To understand LABAs better we must first understand SABAs.

Short Acting Beta Agonists (SABAs): These were revolutionized throughout the course of the 20th century. They are medicines that, once inhaled, join with beta 2 adrenergic receptors lining bronchial muscles causing them to relax. This opens up airways, making breathing easier. This reaction is fast, but short acting.

Examples include:

• Albuterol (Ventolin). It usually lasts 4-6 hours. 
• Levalbuterol (Xopenex). It usually lasts 4-8 hours.

SABAs are often called quick relief, or rescue inhalers, because they work fast to quickly relieve the symptoms of shortness of breath. Experts recommend all asthmatics have one nearby at all times to swiftly end asthma attacks. They should only be used when needed and in accordance with your asthma action plan.

So, now, what are LABAs?

Long Acting Beta Agonists (LABAs). These were revolutionized during the last 20 years of the 20th century. They are medicines that, once inhaled, join with beta 2 adrenergic receptors lining bronchial muscles causing them to relax. This opens up airways, making breathing easier. This reaction is generally slow, but long acting.

Examples include:

• Salmeterol. Works for up to 12 hours. Takes 15-20 minutes to start working.
• Formoterol. Works for up to 12 hours. Works fast like albuterol.
• Vilanterol. Works for up to 24 hours. Takes 15-20 minutes to start working.
• Aformoterol (Brovana). Works up to 12 hours. Works fast like albuterol.

LABAs are often called asthma controller medicines because they help you to control and prevent asthma. They are usually prescribed for moderate and severe asthma and should be used every day.

Combination inhalers. Asthma experts now recommend that LABAs work best when combined with an inhaled corticosteroid. The inhaled corticosteroid controls chronic underlying inflammation to make asthmatic lungs less sensitive to asthma triggers. The LABA keeps airways open long term. Together they work to control and prevent asthma. Combination inhalers are now considered a top-line treatment for asthma and COPD too.

Common combination inhalers include:

• Advair.
• LABA. Salmeterol
• Corticosteroid. Fluticasone
• Symbicort.
• LABA. Formoterol
• Corticosteroid. Budesonide
• Dulera.
• LABA. Formoterol
• Corticosteroid. Mometasone
• Breo.
• LABA. Vilanterol
• Corticosteroid. Fluticasone

Which one works best? While these combination inhalers are all similar, they all work a little bit different, each having slightly different side effects. For instance, some asthmatics prefer Symbicort and Dulera because they contain formoterol and work fast like rescue inhalers. Some don’t like these because they may cause similar side effects as rescue medicine, like jitteriness. Some prefer Breo because it only needs to be taken once a day.

Another option. For those who have trouble using inhalers, another option is Brovana. This comes as a solution and is inhaled by using a nebulizer. It can be combined with Budesonide (Pulmicort) solution to gain the same effect as the combination inhalers mentioned above.

Please note. While most asthma experts agree LABAs are safe, they should not be used more frequently than prescribed. Most asthma experts also agree that if you feel short of breath between LABA doses, it’s safe to use your rescue medicine in accordance with your asthma action plan.

Conclusion. The use of LABAs, coupled with inhaled corticosteroids, is now considered a top-line treatment for controlling and preventing moderate to severe asthma. When used as prescribed they should help prevent -- or at least reduce -- your asthma symptoms and rescue inhaler use. 

Further Reading:

• Rau’s Respiratory Care Pharmacology, pages 108-109
• What Asthma Controller Medicine Works Best For You
• What is Rescue Medicine?
• Symbicort May Offer New Options for Asthmatics
• Don’t Be Afraid to use Advair and Symbicort
• Why I switched from Advair to Breo