Research warns on use of one type of asthma inhaler

Long acting bronchodilators should be banned for use in asthma as single inhaler products because of the increased mortality risk when they are used without an accompanying inhaled steroid, New Zealand researchers say.

A bronchodilator medication dilates the airway that conducts air into the lungs, decreasing airway resistance. Some medications contain a kind of drug called a long-acting beta agonist, or LABA which relaxes the muscles around stressed airways to help patients breathe.

New Zealand respiratory specialist Professor Richard Beasley and colleagues from the Medical Research Institute in Wellington said in a commentary -- published today in international medical journal The Lancet -- that guidelines already recommend against using only long-acting beta agonists (LABA) for asthma, but this will inevitably occur in practice because of poor patient compliance with the separate steroid inhaler.

In today's Lancet article, the researchers said that the risk of LABA monotherapy can be avoided by using combination inhalers containing both a beta agonist and inhaled steroid, and this also has the benefit of promoting increased use of inhaled steroid than when the two drugs are prescribed in separate inhalers.

Use of the combination inhalers has been associated with reductions in asthma mortality, they said.

"Hence we call for the withdrawal of LABAs as single-inhaler therapy, and recommend that LABA use is restricted to being combined with inhaled corticosteroids in inhalers for asthma," they wrote.

"Our recommendation is evidence-based and reduces the potential risks of LABAs while allowing patients to obtain the major symptomatic benefits of this therapy."

But the researchers conceded that single inhalers should be kept on the market for use in the other common obstructive lung disease: chronic obstructive pulmonary disease (COPD), which occurs in about 20 percent of smokers.

Separately, Prof Beasley was last year granted $1.3 million in taxpayer funds by the Health Research Council to study real life use of the Symbicort "smart" regime in adult asthma.

In late 2008, United States government health advisers recommended restrictions on some long-acting asthma drugs Foradil and Serevent but said the benefits of Advair and Symbicort clearly outweighed the risks -- but New Zealand's medicine safety arm Medsafe said it was taking a wait and see approach on regulation.

Since 2005, Medsafe had required warnings that those medicines should only be used in combination with inhaled corticosteroids.