Combination ICS/LABA inhalers
As mentioned earlier, LABA monotherapy is not recommended
in patients with asthma as it does not impact
airway inflammation and is associated with an increased
risk of morbidity and mortality. LABAs are onlyrecommended when used in combination with ICS therapy.
The combination of a LABA and ICS has been
shown to be highly effective in reducing asthma symptoms
and exacerbations, and is the preferred treatment
option in adolescents or adults whose asthma is inadequately
controlled on low-dose ICS therapy, or in children
over 6 years of age who are uncontrolled on
moderate ICS doses [6]. Although there is no apparent
difference in efficacy between ICSs and LABAs given in
the same or in separate inhalers, combination ICS/
LABA inhalers are preferred because they preclude use
of the LABA without an ICS, are more convenient and
may enhance patient adherence. Three combination
ICS/LABA inhalers are available in Canada: salmeterol/
fluticasone (Advair), budesonide/formoterol (Symbicort)
and mometasone/formoterol (Zenhale). Combination
budesonide/formoterol has recently been approved for
use in Canada as a single inhaler for both daily maintenance
(controller) and reliever therapy in individuals 12
years of age and older. It should only be used in patients
whose asthma is not adequately controlled with low-tomoderate
ICS doses or whose disease severity warrants
treatment with combination therapy [4,6].