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Combination Medications – Albuterol Safety

Combination Asthma Medications

Are long-acting and short-acting beta-2 agonists safe?

There are two different types of albuterol often used in the rescue treatment of and asthma attack.  One is a long-acting form of albuterol and the other is the short-acting form. It is important to remember, albuterol alone is not a preventative treatment for asthma. Short acting albuterol is a rescue medication only and long acting albuterol is only a preventative when paired with an inhaled steroid.  Albuterol in either version works to relax the muscles that squeeze the airways shut during an asthma attack.  It is important to understand that albuterol has no effect whatsoever on the inflammation (swelling) that prevents the flow of air through the airways.  The inflammation can only be treated by taking a daily controller medication such as an inhaled corticosteroid.

Long-acting Albuterol (beta-2 agonist) (LABAs)

LABAs open up constricted airways for 12 hours or longer and are used to control moderate to severe asthma.  They are found in the following products:

  • Serevent
  • Advair
  • Foradil
  • Symbicort
  • Dulera

A large recent study known as “SMART” was designed to test the safety of Serevent.  It was stopped early because of safety concerns. The researchers found that people taking Serevent alone, were at a higher risk of life-threatening asthma attacks or death than were people taking a placebo.  As a result of this study, the Food and Drug Administration (FDA) issued a public health advisory for LABA medications in 2005.  It warns that these medications can cause a “small but significant risk in asthma-related deaths.”  The FDA mandated that “black box” safety labels were added to all medications containing a LABA.

It has been well established that LABAs are safe to take only when they are used in combination with an inhaled corticosteroid. LABAs should never be used as the only medication to treat asthma. Advair, Dulera and Symbicort contain both a LABA and an inhaled corticosteroid.  The risk of death or life-threatening asthma attacks are significantly lower with Advair, Dulera and Symbicort.  On the other hand, Foradil and Serevent are only LABA products and should never be taken as the only treatment for asthma.

People who used LABAs along with corticosteroids had fewer symptoms in clinical trials than did people who used only corticosteroids.  Compared with participants who used corticosteroids only, people who took both medications:

  • Woke up less often at night
  • Had better lung function
  • Quality of life improved due to feeling better
  • Used short acting albuterol less often
  • Had fewer asthma exacerbations

Therefore LABAs play an important role in moderate to severe asthma management if they are used properly.

Short-Acting Albuterol (beta-2 agonist) (SABA)

Short acting albuterol is a primary tool in the treatment of mild to severe asthma attacks.  It provides quick relief of wheezing, coughing, shortness of breath and chest tightness within 3-5 minutes of taking it. In some cases, it can be used prior to exercise to prevent the onset of these symptoms. As mentioned previously however, it only works by relaxing the muscles squeezing the airway; it does not reduce the swelling that is also contributing to asthma symptoms. Corticosteroids are the primary medications that reduce swelling in the airways.

People who have poorly controlled asthma will possibly suffer health consequences if they just use albuterol as the only treatment for their asthma. This is due to the fact that short acting albuterol can increase the heart rate and if used too often, can increase the risk of death or a life-threatening asthma attack.  If Albuterol is used too often, it can also saturate the beta-2 receptors in the body and the person can become “immune” to the effects of albuterol.  Therefore, if they do experience a life-threatening asthma attack, albuterol will not work.

The Bottom Line

Continue to work with your healthcare provider to ensure that you are taking the proper medications to control your asthma.  Make sure to voice any concerns you may have and make sure to let your provider know if you are using your short-acting albuterol (ProAir, Proventil, Ventolin) or Xopenex more than twice a week.  Never use Serevent or Foradil as the only treatment for your asthma.

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