New Prescribing Guidelines
Long-Acting Beta-Agonists (LABAs), a class of medications used for the treatment of asthma, now have new recommendations in their drug label intended to promote their safe use in the treatment of asthma.
In February 2010, the agency announced it was requiring manufacturers to revise their drug labels because of an increased risk of severe exacerbation of asthma symptoms, leading to hospitalizations, in pediatric and adult patients, as well as death in some patients using LABAs for the treatment of asthma (see February 2010 LABA Drug Safety Communication).
In June 2010, the agency issued updated recommendations on the appropriate use of LABAs. See June 2010 LABA Drug Safety Communication for more information.
The new recommendations in the updated labels state:
- All LABA are contraindicated in patients with asthma without use of a long-term asthma control medication.
FDA has stated its belief that when LABAs are used according to the recommendations outlined above and in the approved drug labels, the benefits of LABAs in improving asthma symptoms outweigh their risks of increasing severe asthma exacerbations and deaths from asthma.
References
- PERFOROMIST Prescribing Information. Napa, CA: Dey Pharma, L.P. 2010.
- Gross NJ, Nelson HS, Lapidus RJ, et al; Formoterol Study Group. Efficacy and safety of formoterol fumarate delivered by nebulization to COPD patients. Respir Med. 2008;102(2):189-197.
- Mannino DM et al. MMWR Surveill Summ. 2002;51:1-13.
- National Institutes of Health/U.S. Department of Health & Human Services. National Heart Lung and Blood Institute Diseases and Conditions Index. What is COPD? Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html. Accessed July 13, 2011.
- Rodriguez-Roisin R, Anzueto A, Bourbeau J, et al; GOLD Executive Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2009). Global Initiative for Chronic Obstructive Lung Disease website: http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html. Accessed March 8, 2010.
- National Heart Lung and Blood Institute: National Institutes of Health. When you are diagnosed with COPD. Available at: http://www.nhlbi.nih.gov/health/public/lung/copd/breathing-better/taking-action.htm. Accessed July 13, 2011.
- American Lung Association. Living with COPD: a life change. Available at: http://www.lungusa.org/lung-disease/copd/living-with-copd/life-change.html. Accessed July 13, 2011.
- CDC FastStats: Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema. Available at: http://www.cdc.gov/nchs/fastats/copd.htm. Accessed April 11, 2011.
- CDC Vital and Health Statistics. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009. Hyattsville, Maryland. 8/2010.
- U.S. Department of Health and Human Services. Caregiver tip sheet. Available at: http://www.strokecamp.com/content/resourcesCAR/CaregiverTipSheet.pdf. Accessed on July 13, 2011.
- Data on file. Evaluation of concepts for Perforomist. Dey #0257 Final research report (market research). LinguiSearch. March 23, 2011.
- U.S. Department of Health and Human Services/NIH. Living with COPD. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_LivingWith.html. Access July 13, 2011.
- Nelson HS, Gross NJ, Levine B, et al. Formoterol Study Group. Cardiac safety profile of nebulized formoterol in adults with COPD: a 12-week, multicenter, ranodmized, double-blind, double-dummy, placebo- and active-controlled trial [published correction appears in Clin Ther. 2009;31(4):920].
- Proventil HFA Prescribing Information. Kenilworth, NJ: Schering-Plough. 1998.
- Atrovent HFA Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. 2010.
- Combivent Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. September 2010.
- Spiriva HandiHaler Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. and New York, NY: Pfizer Inc. 2010.
- Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol treatment: evidence-based guidelines. Chest. 2005;127(1):335-371.
- Theophylline extended-release tablets prescribing information. Kansas City, MO: Nostrum Laboratories, Inc. May 2009.
- Pari Trek S Compact Compressor Nebulizer System. Instructions for use. Revised 2006.
- Geller DE. Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler. Respir Care. 2005;50:1313-1321.
- Advair HFA Prescribing Information. Research Triangle Park, NC: GlaxoSmithKline. 2011.
- Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J Gen Intern Med. In press.
- Van der Palen J, Klein JJ, Kerkhoff AH, van Herwaarden CL, Seydel ER. Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. Pt Ed Couns. 1997;32:S87-S95.
- Data on file. Survey conducted by KRC Research: COPD Patient and Caregiver Studies, March 2009. Dey Pharma, LP.
- Advair Diskus Prescribing Information. Research Triangle Park, NC: GlaxoSmithKline. 2011.
- Pulmicort Flexhaler Prescribing Information. Södertälje, Sweden: AstraZeneca. 2010.
- Mayo Clinic. Asthma inhalers: which one’s right for you? Available at: http://www.mayoclinic.com/health/asthma-inhalers/HQ01081/METHOD=print. Accessed August 22, 2011.
- American Lung Association of Minnesota/Minnesota COPD Coalition/NCQA Certified Disease Management. Understanding & managing your chronic obstructive pulmonary disease (COPD) brochure. 09/07.
- Ventolin HFA Prescribing Information. Research Triangle Park, NC: GlaxoSmithKline. 2009.
- American Lung Association. My COPD Action Plan. Available at: http://www.lungusa.org/lung-disease/copd/living-with-copd/copd-management-tools.html. Accessed August 22, 2011.
- American Thoracic Society. Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine. 1995;152:S77-S120
- National Heart, Lung, and Blood Institute: National Institutes of Health. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Full Report 2007.
- Symbicort Prescribing Information. Dunkerque, France: AstraZeneca. 2010.
- Centers for Medicare & Medicaid Services. Department of Health and Human Services, USA. Medicare and Home Health Care. Available at: www.medicare.gov.
- Centers for Medicare & Medicaid Services. Medicaid Program—General Information: Overview. Available at: www.cms.gov/MedicaidGenInfo/. Accessed June 23, 2011.

