Clinical use of combination therapy

• symptoms,

• quality of life,

• lung function, and

• exacerbation rates

than would be achieved by doubling the dose of ICS.^10,11,12,13

In symptomatic adult patients, there is Level 1 evidence indicating that adding a LABA is more effective than increasing the dose of ICS. Studies have shown this is true for dose ranges of ICS from 400-1000mcg daily budesonide (BUD)/beclomethasone (BDP) or equivalent and 200-800mcg daily in children.¹³

LABAs achieve better control of asthma symptoms without the adverse effects that may occur with additional high doses of ICS.

As LABAs produce prolonged bronchodilation (up to 12 hours), they can be combined with ICS and given in a twice-daily dosing regimen. The combination can achieve improved asthma control in symptomatic patients when the total ICS dose is unchanged, or can maintain stability in well-controlled patients when the total ICS dose is reduced.^14,15,16 

Adverse effects are pharmacologically predictable, based on the beta-adrenergic activity of LABAs (tremor, tachycardia, palpitations and headache) and are no different when the drugs are administered in separate devices or together in one device.⁹,¹⁷ Similarly, there is no evidence that administration of a LABA and ICS in a single device alters the adverse effect profile of ICS, although long-term studies are awaited. 

The combination of a LABA and ICS should be considered when:

1  Symptoms or sub-optimal lung function persist on ICS alone. 

2  It is desirable to reduce the current dose of ICS while maintaining optimal asthma control.

3  Initiating asthma treatment in a patient in whom rapid symptom improvement is needed.