You take your asthma medications faithfully to avoid life-threatening asthma attacks. So, recent news about one class of asthma drug, the long-acting bronchodilators, may leave you unsettled. These drugs are now labeled with a warning that the medication itself can raise the risk for such an attack. Don't just stop taking any of your asthma medications, though. Talk to your doctor first. When used properly with other medication, long-acting bronchodilators are still effective for many with moderate to severe asthma.

What are long-acting bronchodilators?
Many people with asthma take medications called long-acting bronchodilators or long acting beta-2 agonists (LABAs). They include:

• Serevent (salmeterol)
• Foradil (formoterol)
• Advair (salmeterol and a corticosteroid)
• Symbicort (formoterol plus a corticosteroid)

Bronchodilators relax airways. Once airways relax, they can open up and let you breath easier. This helps relieve wheezing and shortness of breath. Long-acting bronchodilators:

• Take effect after 30 minutes and can give symptom relief for 12 hours.
• Do not take effect right away, so they cannot be used as rescue inhalers (like albuterol) to stop an asthma attack after symptoms start.
• Should not be used as stand-alone medication for asthma in adults or children.
• Should only be used for the shortest time possible to achieve asthma control. Your doctor may stop the LABA, if possible, once control is achieved.

Advair and Symbicort combine both a long-acting bronchodilator and a corticosteroid. These two inhalers are often effective treatments for many with moderate to severe asthma when another controller medication alone is not enough.

What about Serevent or Foradil?
Serevent and Foradil are inhaler medications that only contain a long-acting bronchodilator drug. They lack the corticosteroid that stops the underlying inflammation. So Serevent and Foradil should not be taken alone to control asthma. They must be used with another controller medicine. Work with your doctor to make sure that you are taking both the LABA and the controller medicine correctly. Serevent or Foradil can be used alone, though, to treat other lung diseases like COPD.

What are short-acting bronchodilators?
Short-acting bronchodilators (quick relief medicine) reverse airway constriction quickly. These medicines are used as rescue inhalers to treat acute symptoms and asthma flare-ups. An example is albuterol (Proventil, Ventolin).

Why the warnings?
Studies of Serevent and Foradil show that they do help to control asthma symptoms. But, people with asthma who take these inhalers also had more severe and life-threatening asthma attacks. Some died.

The FDA committee found that some people who had dangerous asthma attacks were using Serevent and Foradil only without taking an inhaled corticosteroid.

Current asthma treatment guidelines call for a corticosteroid controller medication as a first-line treatment for moderate or severe asthma. A corticosteroid is often the best drug to control the inflammatory part of asthma.

People in the study may have been prescribed a separate steroid inhaler, but forgot to take it because the Serevent or Foradil gave them enough symptom relief. The current label warnings now make it clear that LABAs should never be used alone to treat asthma.

What about Advair and Symbicort?
Advair and Symbicort deliver both a long-acting bronchodilator and a steroid anti-inflammatory treatment. With these drugs, there is no danger that someone will forget to take a long-term controller steroid medicine. Your doctor may prescribe either Advair or Symbicort when another controller medication alone is not enough to control asthma.

Are there still benefits to long-acting bronchodilators?
Studies show that taking a long-acting bronchodilator with a steroid may relieve asthma symptoms better than taking just a steroid. Combining the two can also help prevent nighttime asthma and exercise-induced asthma in some people.

What does this mean for me?

• Do not stop taking Serevent or Foradil for asthma if you have been prescribed these drugs. See your doctor. You and your doctor will decide which treatment is best for you.
• If you have moderate or severe asthma, keep taking your controller medications as directed even if you have no asthma symptoms. Keep your checkups so that your asthma treatment plan can be reviewed and changed as needed.
• If you are taking Serevent or Foradil for COPD (emphysema, chronic bronchitis), keep taking them as directed. The warnings do not apply to these inhalers used for COPD or certain other lung conditions.
• If you are using a quick relief medicine (like albuterol) more than twice a week, your asthma may not be well controlled. See your doctor right away.

By Louis Neipris, M.D., myOptumHealth
Sighted www.mysuncoast.com, 12 July 2010
Original: myOptumHealth.com