Long-Acting Beta2-Agonists
Long-acting beta2-agonists, including salmeterol (Serevent) or formoterol (Foradil), plus inhaled corticosteroids are now the preferred preventive treatment for adults and children with moderate to severe asthma. Long-acting beta2-agonists are used for preventing an asthma attack (not for treating symptoms). The effects of one dose of a long-acting beta2 agonist last for about 12 hours, so they are particularly effective during the night. These drugs also may be used for prevention of exercise-induced asthma in people and to protect against aspirin-induced asthma.
In comparison studies, salmeterol and formoterol appear to be equally beneficial. Formoterol has a much faster action, however, and may achieve better control of nighttime asthma. Formoterol works almost as fast as the short-acting albuterol and is sometimes used to treat asthma symptoms. Salmeterol should never be used for treatment of acute episodes. For this purpose, short-acting bronchodilators should be used. (Formoterol has a faster action and may sometimes be used for treating symptoms, but patients should check with their doctor.)
Long-acting forms are not used alone on any regular on basis, since they may reduce the effectiveness of the short-acting beta2-agonists (the mainstays for treating acute attacks). In patients with moderate to severe asthma, the long-acting beta2-agonists are best used in combination with anti-inflammatory drugs. Unlike short-acting forms, these beta2-agonists may even have anti-inflammatory properties.
Single devices that contain both drugs are now available in the U.S. (Advair) and parts of Europe (Seretide, Symbicort). These inhalers appear to be safe and possibly more effective than either drug used alone for patients who do not respond well to other drugs.
Side Effects. Side effects of long-acting beta2-agonists are similar to the short-acting drugs.
Specific Warning on Salmeterol and Formoterol. In 2003, a "black box" warning was added to product packaging for drugs that contain salmeterol, including Serevent Diskus, and Advair Diskus. The warning was based on a study that demonstrated more serious and even fatal asthma episodes in patients who used the drug than in patients who used a placebo. The risk for serious asthma episodes with salmeterol appears to be highest in African Americans and elderly patients with severe asthma.
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