Once Asthma is Under Control, Should LABA Tx Be Stopped?
Long-acting beta2-agonists (LABA) are often prescribed to adults with asthma not well controlled by inhaled corticosteroid (ICS) treatment but may carry an increased risk of serious adverse events and mortality. An article in the Cochrane Library highlights five studies on cessation of LABA compared to continued use of LABA/ICS for adults with well-controlled asthma to determine whether stopping LABA treatment has an impact on asthma control, exacerbations, and other serious adverse events.
All five studies included were multicenter randomized parallel-group controlled trials with a total of 2,781 adults with stable asthma. Four studies focused on agents that included salmeterol (salmeterol/fluticasone 50/250mcg, salmeterol/fluticasone 50/100mcg); formoterol/budesonide 9/160mcg was included in the fifth study. Patients used albuterol as the rescue medication for acute exacerbations in all five studies.
Patients who stopped LABA had more exacerbations compared to those on LABA/ICS (32 per 1,000 patients vs. 19 per 1,000 patients, respectively) and worse scores on the Asthma Control Questionnaire. Measures of asthma-related quality of life were lower with LABA discontinuation, but these were not clinically relevant. Too few serious adverse events were reported to determine an effect.
The Food and Drug Administration (FDA) requires a warning on LABA labels regarding the risk of asthma-related death and that “once asthma control is achieved and maintained, patients should be assessed at regular intervals and step down therapy should begin (e.g., discontinue LABA), if possible without loss of asthma control, and the patient should continue to be treated with a long-term asthma control medication, such as an inhaled corticosteroid.” Although this review does suggest an increased risk of asthma exacerbations with stopping LABA therapy, more research is needed on outcomes such as exacerbations requiring hospitalization and severe adverse events.