![]() ![]() ![]() Monitoring of serum theophylline concentration is essential. Theophylline may have mild anti-inflammatory effects. Sustained-release theophylline is a mild to moderate bronchodilator used as alternative, not preferred, adjunctive therapy with ICS. For patients who have more severe persistent asthma (i.e., those who require step 4 care or higher), the Expert Panel continues to endorse the use of a combination of LABA and ICS as the most effective therapy. For patients inadequately controlled on low-dose ICS, the option to increase the ICS dose should be given equal weight to the addition of a LABA. ![]() The Expert Panel concluded that LABAs should not be used as monotherapy as long-term control medication in persistent asthma but that LABAs should continue to be considered for adjunctive therapy in patients >5 years of age who have asthma that requires more than low-dose ICS. The Expert Panel reviewed the safety data provided to the FDA Pulmonary and Allergy Drugs Advisory Committee as well as the extensive accumulation of clinical trials and meta-analyses on the use of LABA, both as monotherapy and in conjunction with ICS. Safety issues have been raised regarding LABAs.LABA may be used before exercise to prevent EIB, but frequent and chronic use of LABA for EIB may indicate poorly controlled asthma which should be managed with daily anti-inflammatory therapy.Studies are underway examining the potential use of formoterol in acute exacerbations and in adjustable-dose therapy in combination with ICS. Use of LABA is not currently recommended to treat acute symptoms or exacerbations of asthma.LABAs are not recommended for use as monotherapy for long-term control of persistent asthma. Of the adjunctive therapies available, LABA is the preferred treatment to combine with ICS in youths >12 years of age and adults. LABAs are used as an adjunct to ICS therapy for providing long-term control of symptoms.The Expert Panel concludes the following regarding the use of LABAs (EPR-3, p. In the opinion of the Expert Panel, the use of LABA for the treatment of acute symptoms or exacerbations is not currently recommended.Frequent and chronic use of LABA for EIB is discouraged, because this use may disguise poorly controlled persistent asthma. LABA may be used before exercise to prevent exercise-induced bronchospasm (EIB), but duration of action does not exceed 5 hours with chronic regular use.For patients >5 years of age who have severe persistent asthma or asthma inadequately controlled on step 3 care, the combination of LABA and ICS is the preferred therapy. For patients >5 years of age who have moderate persistent asthma or asthma inadequately controlled on low-dose ICS, the option to increase the ICS dose should be given equal weight to the option of adding LABA. ![]() In the opinion of the Expert Panel, the beneficial effects of LABAs in combination therapy for the great majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher), should be weighed against the increased risk of severe exacerbations, although uncommon, associated with the daily use of LABAs.Of the adjunctive therapies available, LABA is the preferred therapy to combine with ICS in youths >12 years of age and adults.LABAs are used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children >5 years of age and adults) (Evidence A for >12 years of age, Evidence B for 5–11 years of age).LABAs are not to be used as monotherapy for long-term control of asthma.Salmeterol and formoterol are bronchodilators that have a duration of bronchodilation of at least 12 hours after a single dose. ![]()
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