- With Mayo Clinic asthma and allergy specialist
James T C Li, M.D., Ph.D.
read biographyclose windowBiography of
James T C Li, M.D., Ph.D.
James Li, M.D.
"People with allergy or asthma can lead full and healthy lives." — Dr. James Li
Dr. James Li is chair of the Division of Allergic Diseases in the Department of Internal Medicine and a board-certified asthma and allergy specialist. He hopes his expertise and the information on the site educates health care consumers in an area of rapid change both in medications and diagnoses.
"There are a lot of misperceptions about allergy and asthma," says Dr. Li, a New York City native who has been with Mayo since 1985 and works with a group of subspecialists in allergy, asthma and immunology. "I believe it's important to provide truthful, accurate information about allergy and asthma to the public. The more people know, the better they can take care of these conditions."
Dr. Li is a professor of medicine at College of Medicine, Mayo Clinic. He's a past director of the American Academy of Allergy, Asthma & Immunology, the American Board of Allergy and Immunology, and the American Board of Internal Medicine. He's a fellow in the American College of Allergy, Asthma & Immunology.
The American College of Allergy, Asthma & Immunology honored him with the Distinguished Service Award, and the American Academy of Allergy, Asthma & Immunology with its Special Recognition Award.
Tests and diagnosis (1)
- Reactive airway disease: Is it asthma?
Causes (1)
- Asthma and acid reflux: Are they linked?
Treatments and drugs (2)
- LABAs for asthma — Should I stop taking them?
- Albuterol side effects: What's normal?
Lifestyle and home remedies (3)
- Ozone air purifiers: Can they improve asthma symptoms?
- Asthma diet: Does what you eat make a difference?
- Asthma: Why are symptoms worse during my period?
Prevention (1)
- Hygiene hypothesis: Early germ exposure prevents asthma?
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Question
LABAs for asthma — Should I stop taking them?
I've heard that long-acting beta agonists (LABAs) can cause severe asthma attacks. Should I stop taking them?
Answer
from James T C Li, M.D., Ph.D.
In some studies, long-acting beta agonists (LABAs) have been linked to life-threatening asthma attacks. The risk appears to be greatest when a LABA is used without also using an inhaled corticosteroid. In contrast, taking an inhaled corticosteroid along with a LABA is appropriate treatment for many people who have asthma. Don't stop any of your asthma medications before checking with your doctor first.
LABAs are used on a regular schedule to open up narrowed airways and prevent asthma attacks. But because they increase the risk of having a life-threatening asthma attack, the Food and Drug Administration warns that LABAs should never be used without an inhaled corticosteroid. So if you're taking a LABA without an inhaled corticosteroid, check with your doctor.
LABAs include:
- Salmeterol (Serevent)
- Formoterol (Foradil, Perforomist)
- Arformoterol (Brovana)
A LABA should be taken with an inhaled corticosteroid, such as:
- Fluticasone (Flonase, Flovent HFA)
- Budesonide (Pulmicort Flexhaler, Pulmicort Respules, Rhinocort)
- Mometasone (Asmanex)
- Flunisolide (Aerobid, Aerospan)
- Beclomethasone (Qvar, Qnasl)
One option is to take a single medication that combines both a LABA and a corticosteroid. There are three of these medications on the market:
- Salmeterol and fluticasone (Advair)
- Formoterol and budesonide (Symbicort)
- Formoterol and mometasone (Dulera)
Children who need both a LABA and a corticosteroid should take them only as a combination medication, and not as separate medications.
The benefits of LABAs to keep asthma under control generally outweigh the risks — if they're used as recommended. If you have any questions about your asthma medications, talk to your doctor. To be safe:
- Confirm with your doctor that you know how to take your medications. If you don't take LABAs or other asthma medications exactly as prescribed, you may be increasing your risk of an asthma attack. Always talk to your doctor before making medication changes or stopping a medication.
- Keep a quick-relief (rescue) inhaler on hand. LABAs don't treat sudden (acute) asthma symptoms. An albuterol inhaler or other quick-relief inhaler can prevent an asthma flare-up from becoming a severe asthma attack.
- Meet with your doctor on a regular basis. Asthma symptoms change over time, so the medications you need may change as well. If your asthma can be controlled without a LABA, your doctor may recommend that you stop using one.
- Talk to your doctor if your asthma isn't under control. The frequent need to use a quick-relief inhaler is a common sign of poorly controlled asthma. Talk to your doctor about other signs that your asthma may not be under control — and what to do if it isn't.
LABAs are sometimes used to treat chronic obstructive pulmonary disease (COPD). When used for COPD, LABAs don't have the same risks that are associated with asthma, so these warnings and recommendations don't apply.
Next questionAlbuterol side effects: What's normal?
- Lemanske RF. Beta agonists in asthma: Controversy regarding chronic use. http://www.uptodate.com/index. Accessed Sept. 20, 2012.
- Morales DR, et al. Long-acting beta-agonist prescribing in people with asthma in primary care. Thorax. In press. Accessed Sep 20, 2012.
- FDA drug safety communication: Drug labels now contain updated recommendations on the appropriate use of long-acting inhaled asthma medications called long-acting beta-agonists (LABAs). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm213836.htm. Accessed Sept. 20, 2012.
- AAAAI allergy and asthma medication guide. http://www.aaaai.org/conditions-and-treatments/treatments/drug-guide/inhaled-corticosteroids.aspx. Accessed Oct. 9, 2012.
- Brozek JL, et al. Long-acting beta-agonist step-off in patients with controlled asthma. Archives of Internal Medicine. In press. Accessed Sep. 27, 2012.
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