Long-acting beta2-agonists as an inhaled corticosteroid-sparing agent for chronic asthma in adults and children

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

“…87 Although there is no standard recognized rationale for why combination epinephrine and dexamethasone would be synergistic in infants with bronchiolitis, evidence in adults and children older than 6 years with asthma shows that adding inhaled long-acting β agonists to moderate/high doses of inhaled corticosteroids allows reduction of the corticosteroid dose by, on average, 60%. 88 Basic science studies focused on understanding the interaction between β agonists and corticosteroids have shown potential mechanisms for why simultaneous administration of these drugs could be synergistic. [89][90][91][92] However, other bronchiolitis trials of corticosteroids administered by using fixed simultaneous bronchodilator regimens have not consistently shown benefit [93][94][95][96][97] ; hence, a recommendation regarding the benefit of combined dexamethasone and epinephrine therapy is premature.…”

Steroids in Asthma: Friend or Foe

“…LABA permit a reduction of 37% (253 mcg BDP) in subjects on minimum maintenance ICS and up to 60% (300 mcg FP) in subjects on maintenance ICS without deterioration in asthma control. They are most effective when combined with ICS, and this combination therapy is the preferred treatment when a medium dose of ICS alone fails to achieve control of asthma (Gibson, 2005). The addition of a LABA to a daily regimen of ICS improves symptom scores, decreases nocturnal symptoms, improves lung function, decreases the use of relief medication, reduces the number of exacerbations and achieves clinical control of asthma in more patients, more rapidly, and at a lower dose of ICS, than ICS given alone (Greening,1994, Pauwel, 1997.…”

Update in paediatric asthma management: Where is evidence challenging current practice?

“…The majority of children with persistent asthma will achieve good symptom control with ICS alone (step 2) and only a minority will need to be considered for step 3 of a step–based approach to asthma management. While evidence supporting a generalisable benefit of add‐on LABA therapy has been shown for adults in various asthma control measures, 6,7 the evidence of a comparable benefit in children is lacking 8 . A Cochrane review in 2009 of the paediatric studies published to date reported only modest, and expected, increases in pulmonary function but no generalised improvement in other measures of symptom control and a suggestion of an increase in exacerbation risk 9 .…”