• The US FDA is investigating the safety of LABAs in asthma
• Safety concerns are focussed on use of LABAs as a stand-alone treatment
• Australian treatment guidelines do not recommend this type of use
• Patients currently taking LABAs should consult their doctor or pharmacist if they have concerns

In the USA, LABAs may be used as a stand-alone treatment, which appears to have contributed to the current concerns about safety. Use of LABAs in Australia has always been quite different and more cautious than the USA. In Australia, these medications may only be prescribed and used in combination with inhaled corticosteroids.

In recent years, the use of LABAs has grown dramatically but safety concerns have arisen about their use in asthma. A very large US based study by Nelson on LABAs demonstrated an increased risk of serious worsening of asthma leading to hospitalisation and death ¹. This was then followed by a systematic review of all the available literature on these medications, which found again that there was an increased risk of serious asthma leading to hospitalisation, increased intubation in intensive care and, although it was very rare, asthma-related deaths ².

The findings of this review were heavily influenced by the large trial conducted by Nelson ¹. Investigators and experts have criticised this trial for not ensuring that all patients were also taking inhaled corticosteroids when they were treated with LABAs. It is well established that inhaled corticosteroids are able to modify the inflammation associated with asthma, reducing the risk of serious asthma. Concerns have been raised that the use of LABAs alone would only mask asthma symptoms, and when an acute flare-up of asthma occurred, make the airway narrowing worse and less responsive to reliever medication such as salbutamol.

To answer this, another group has recently reviewed the studies that used LABAs but also insisted that all participants must first be on an inhaled corticosteroid ³. When this was the case there was no increased risk of acute asthma or hospitalisation, and deaths were very rare but there appeared to be no association.

The National Asthma Council Australia recommends a stepwise approach to asthma care. In those with persistent asthma symptoms it is recommended that they be treated with an inhaled corticosteroid regularly. This has been shown to reduce symptoms and reduce the risk of acute asthma in both adults and children. In adults, and children over the age of 12 years, who have persisting symptoms despite the use of inhaled corticosteroids,  the addition of a LABA leads to better symptom control and reduces the risk of acute flare-ups of asthma, but only when used concurrently with an inhaled corticosteroid. When this is the case, these medications are effective and very valuable in the control of asthma, especially in those with more severe disease.