Elsevier

The Lancet

Volume 376, Issue 9743, 4–10 September 2010, Pages 750-751
The Lancet

Comment
Call for withdrawal of LABA single-therapy inhaler in asthma

https://doi.org/10.1016/S0140-6736(10)61158-0Get rights and content

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    Short-acting β2-agonists (SABA) provide short-term relief (onset of action in 5 min, duration 4−6 h), while long-acting β2-agonists (LABA) deliver a longer (more than 12 h) bronchodilation [62]. The reduction of AHR by LABA without abating the airway inflammation, leads to false perception of controlling the disease, and result in uncontrolled progression of the inflammatory process [95]. For controlling airway inflammation and preventing damage/remodeling of the airways, inhaled corticosteroids (ICS) are the first line of treatment and, in combination with LABA, they are regarded as the gold standard in the management of asthma.

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    Moreover, an important advantage of combining ICS and LABA in 1 inhaler is the prevention of LABA use as monotherapy, which carries potential increased risk of asthma-related mortality. Since 2005, LABA monotherapy has been accompanied by a Food and Drug Administration (FDA) “black box” warning in the United States.35,36 In 2010, the FDA recommended the use of FDC products to ensure compliance with concomitant therapy in pediatric and adolescent patients.37

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    Patients were all taking maintenance ICS prior to randomised treatment administration, suggesting that the observed bronchodilator response is likely to have been due mainly to the VI component. VI was administered in the combination FF/VI ELLIPTA DPI, as this is the formulation in which VI will be available for use in adults with asthma; there is no separate VI inhaler product available for use in adults with asthma, thereby avoiding possible LABA monotherapy, if ICS and LABA therapy is prescribed as separate inhalers [32]. Although both the FF/VI 100/25 mcg and 200/25 mcg preparations are the once-daily doses recommended in asthma, based on the clinical trials in which efficacy has been demonstrated [16–18], we examined the FF/VI 100/25 mcg preparation as this is the dose likely to be most commonly used in clinical practice.

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