Another Reassuring Study on LABA–ICS Safety in Asthma

David J. Amrol, MD

Journal Watch

Abstract and Introduction

Abstract

When used with inhaled corticosteroids, long-acting β-agonist bronchodilators reduce asthma exacerbations.

Introduction

For the past 2 decades, a combined regimen of inhaled corticosteroids (ICS) and long-acting β-agonists (LABAs) has been considered first-line therapy for asthma that is uncontrolled on ICS monotherapy. The combination reduces symptoms and exacerbations and improves lung function and quality of life. However, in an earlier large safety trial, LABAs were associated with asthma-related deaths, particularly among black patients (JW Gen Med Feb 17 2006); an unresolved issue is whether this association is mitigated when LABAs are used with ICS.

In this population-based, observational study from Michigan, 1828 asthma patients (age range, 12–56) who received either ICS alone or an ICS–LABA combination were followed for a mean of 2.1 years; the primary endpoint was severe exacerbations (i.e., need for oral steroids, asthma-related emergency department visit, or asthma-related hospitalization). Pharmacy data were used to estimate ICS and LABA exposure. Combined therapy had a protective effect on exacerbations compared with ICS monotherapy (hazard ratio, 0.65 vs. 0.72). The effect was greatest in patients who had moderate-to-severe or severe asthma, or were aged 18 and older, male, or black.

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