![]() There were no asthma deaths in either group and just two life-threatening attacks, making it impossible to assess any differences in these outcomes. AUSTRI compared LABA/steroid combinations with a steroid alone in nearly 12,000 adults with asthma. Food and Drug Administration to address the dangers of LABAs. ![]() The 2016 AUSTRI trial was one of five commissioned by the U.S. 4 An identical 40% increase was seen in the Salmeterol Multicenter Asthma Research Trial (SMART odds ratio = 1.4, 0.7 to 2.9), 1 although in both cases, the results were statistically insignificant. The authors' estimate for increased overall deaths was an odds ratio of 1.4 (0.6 to 3.4), suggesting the possibility of a 40% relative increase. An updated 2014 review could neither confirm nor refute this danger, perhaps because of a lack of power. Two large reviews found that LABAs increase fatalities even when combined with steroids, 2, 3 suggesting approximately one in 1,400 patients will experience an asthma-related death. Previous reviews have reached differing conclusions concerning safety. Adding a LABA also improved symptoms more than increasing the steroid dose, but at levels modest enough that asthma-related quality of life was unchanged. The more severe the asthma, the more likely the benefit. Moreover, for those with a 20% short-term risk of attack, one in 45 patients benefited for those with a 1% risk of attack, one in 673 benefited. However, adding a LABA did not reduce hospitalizations, deaths, or severe attacks. One in 73 patients in the LABA/steroid group avoided a mild attack (defined as requiring three to five days of oral steroids). The relevant Cochrane review examined 48 trials of more than 33,000 patients with asthma, assigning one group to a higher steroid dose and the other to a LABA/steroid. We focused on trials addressing a common and relevant clinical dilemma among patients with asthma: When taking an inhaled steroid and seeking better control, should the steroid dose be increased or should a LABA/steroid combination be used? There are many LABA and LABA/steroid comparisons. 1 This summary examines the effectiveness and safety of LABAs when combined with steroids. ![]() LABAs increase severe attacks and asthma deaths when used alone. Although inhaled steroids are the accepted first-line controller, adding LABAs is common. Narrative Long-acting beta agonists (LABAs) relax smooth muscle in asthmatic lungs, potentially preventing attacks and improving symptoms.
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