Higher doses of corticosteroids do not improve symptoms for all patients and can have significant side effects, while long-acting beta agonists
have come under scrutiny for their risk of worsening asthma symptoms that could result in hospitalization and, rarely, death.
Although the risks of single-agent LABAs are well documented, in children and adults, there is not enough information to conclude that "use of the combination mitigates this risk that we know pertains to the long-acting beta agonists
Nelson et al (20) compared the efficacy and safety of a combination of inhaled steroid and long-acting beta agonist
(fluticasone and salmeterol) with an inhaled steroid and a leukotriene-receptor antagonist (fluticasone and montelukast).
In pre-specified pooled analyses, revefenacin produced increases in trough FEV1 in the subgroup (38%) of patients using background long-acting beta agonist
(LABA) containing therapies and in the subgroup of patients who were not using concomitant LABA therapy.
Safety concerns regarding long-acting beta agonist
(LABA) therapy date back to a major study reported more than 7 years ago, and a 2008 FDA meta-analysis indicated that treatment with LABAs--either alone or combined with an inhaled corti-costeroid (ICS)--is associated with an increased risk of severe asthma symptoms and hospitalizations as well as deaths in adults and children with asthma, compared with people not on a LABA.
Anoro is a once-daily combination treatment comprised of two bronchodilators, umeclidinium (UMEC), a long-acting muscarinic antagonist (LAMA), and vilanterol (VI), a long-acting beta agonist
(LABA), in a single inhaler, the Ellipta.
Relovair is an investigational drug which combines fluticasone furoate (FF; an inhaled corticosteroid or ICS) and vilanterol trifenatate (VI; a newly developed long-acting beta agonist
or LABA) in a once-daily treatment for patients with COPD or asthma.