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as regular preventive therapy may be at increased risk of side effects,
including death. As this issue still remains, the FDA does not approve the use
LABAs for asthma as single therapy but does approve the use in combination
with inhaled steroids. Some brand names include: Serevent, Foradil, Arcapta,
Vilanterol, Striverdi.
4. Inhaled Combination Corticosteroid-Long-Acting Beta 2-
Agonists (ICS/LABA)
The addition of long-acting anti-bronchospasm agents (beta 2-agonists) is
beneficial in those patients who, in spite of adequate inhaled corticosteroid
use, continue to have activity interference, symptoms, and a need for rescue
asthma inhalers. Many patients are needlessly prescribed combination
therapy due to failure to adequately deliver inhaled steroids (most often due
to poor inhaler technique). Some brand names include: Advair, Symbicort,
Breo, Dulera.
5. Other Stuff
a. Anticholinergics
Inhaled medications primarily used to treat COPD, although may be
beneficial for many asthmatics. Short acting anticholinergics are not FDA
approved for asthma but are clearly useful instead of short-acting beta 2-
agonists for people who cannot take usual SABA rescue medication.
Some brand names for short acting agents include: Atrovent, Atrovent
HFA, Robinul, Combivent (a combination of Atrovent with Albuterol).
Spiriva, a long-acting anticholinergic agent (LAMA) is FDA approved for
use in patients uncontrolled on ICS/LABA therapy. Some brand names of
other LAMAs include: Spiriva, Turdoza, Seebri, Incruse.
b. Inhaled Cromolyn
Basically, extremely poor medications compared to inhaled steroids for
long-term preventive control. These agents work best when used
immediately prior to allergen (animal) exposure to prevent allergen
(animal) induced asthma attacks. They may also have a limited role as
additional agents to beta 2-agonists for prevention of exercise-induced
asthma. Available only for nebulizer use in the US, the only brand name
is: Intal.
c. Methylxanthines
Basically, after 50 years of use, a class of medications still looking for a
reason to be prescribed. Once a mainstay of therapy, the use of these
medications has fallen into disfavor due to a high level of side effects and
inadequate benefit. Due to widespread misuse, these medications should
only be prescribed by a specialist familiar with the risks. Some brand
names include: Theophylline, Slobid, Theodur, Theo24, and Uniphyl.