Clinical Use of Symptom Controllers
As clinical experience with long-acting beta2 agonists has increased over recent years, their role in treating asthma has broadened to include:
- Nocturnal asthma:
The extended duration of action of long acting beta2, agonists makes them ideally suited for prevention of nocturnal asthma which continues to occur despite use of appropriate preventive medication. - Exercise-induced asthma:
Exercise-induced asthma (EIA) can in some patients continue to be a problem, despite otherwise good control of asthma symptoms. This can be a significant management problem for young school-aged children where teachers do not always supervise medication use and the child cannot be relied upon to remember to self-medicate before exercise. Administration of a long-acting beta2, agonist can provide protection against EIA, particularly for the child at school. - Maintenance treatment of asthma:
Studies in adults with asthma show that long-acting beta2 agonists are of benefit in the maintenance treatment of asthma and that the addition of long-acting beta2 agonists in many patients is a more effective alternative to increasing the dose of inhaled corticosteroid.
Long-acting beta2 agonists are
indicated for the long-term regular treatment of
reversible airways obstruction in asthma (including
nocturnal and exercise-induced asthma) in patients
who are receiving inhaled or oral corticosteroids.
They should not be used in patients whose asthma can
be managed by occasional use of short-acting inhaled
beta2 agonists.
| In children who require continuing treatment with inhaled corticosteroids, the addition of long-acting beta2, agonists should be considered when the dose of inhaled corticosteroid reaches a level where the risk of adverse effects becomes significant This point cannot be precisely quantified and the decision must be made on an individual basis taking into account the age and size of the child, the current dose of inhaled steroid, any adverse effects, and the impact of the continuing asthma symptoms on the child. As a guide, the addition of long-acting beta2 agonists should be considered when the dose of inhaled corticosteroid required for continuing treatment reaches about 800-1000m g/day of BDP or budesonide and about 500m g/day of fluticasone. |
The guidelines for including long-acting beta2 agonists in an adult treatment regime are similar to those for children. The point of introduction for adults is equally difficult to quantify. The upper dose of inhaled corticosteroid may be limited by patient intolerance of any adverse effects, or the need to limit potential adverse effects from high doses over a prolonged period of time. This is an important consideration as it is possible that high doses of inhaled corticosteroids over prolonged periods may cause long-term systemic side effects, such as cataract development or glaucoma.
If a patient fails to receive clinical benefit from long-acting beta2 agonists after 1 month, the therapy should be withdrawn.
PRECAUTIONS
The management of asthma should normally follow a stepwise program, and patient response should be monitored clinically and by spirometry. These agents should not be initiated in patients with unstable or acutely deteriorating asthma. Please read the product information supplied by the pharmaceutical companies for more detailed information.
PBS LISTING
RESTRICTED BENEFIT:
"Patients with frequent episodes of nocturnal asthma who are receiving treatment with oral corticosteroids or maximal doses of inhaled corticosteroids."
ADVERSE REACTIONS
Pharmacologically predictable side effects of beta2 agonists may occur. These include tremor, tachycardia, palpitations, headache and dizziness, although they tend to be transient and may reduce with regular therapy. As with other inhalation therapy, paradoxical bronchospasm may occur in very rare cases. Please read the product information supplied by the pharmaceutical companies for more detailed information.
CONTRAINDICATIONS
Hypersensitivity to any ingredient of the preparation.