oa Current Allergy & Clinical Immunology - Combination of inhaled steroid and long-acting beta-2-agonist therapy - use and limitations : review article

Volume 25, Issue 2
  • ISSN : 1609-3607



The combination of inhaled corticosteroids (ICS) and long-acting beta-2-agonists (LABAs) has an important place in new asthma guidelines as an option for asthma that is not controlled on low- or medium-dose ICS after consideration has been given to adherence and technique. The rationale for their use is due to both complementary and synergistic mechanisms of action. Combination therapy may have different efficacy in different age-groups and, because of patient variability, it may not always be the most effective treatment modality. The addition of LABAs to ICS (or combination therapy) is not first-line therapy and should be restricted to patients who truly need them. LABAs are not recommended for children under the age of 5. Patients on combination therapy should be weaned off the LABA when control is achieved. LABAs should never be used as monotherapy. Single inhaler use of LABAs administered sequentially in separate inhalers from ICS is prone to possible misuse. Fixed-dose combination products are thus preferred as they avoid this possibility.

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