Types of Long-Acting Inhaled Bronchodilators
Long-acting inhaled bronchodilators — such as long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) — are used to treat patients with chronic obstructive pulmonary disease (COPD). They function by expanding the airways and helping them stay expanded for a longer period of time.
Rather than a short-term inhaler, these medicines are meant to be used on a long-term basis for the maintenance treatment of COPD. Many are prescribed twice daily to prevent COPD symptoms such as wheezing, coughing, chest tightness, and shortness of breath.
LABAs available in the United States include:
- Brovana (arformoterol)
- Perforomist (formoterol)
- Foradil (formoterol)
- Arcapta (indacaterol)
- Serevent Diskus (salmeterol)
- Striverdi Respimat (olodaterol)
LAMAs available in the United States include:
- Spiriva (tiotropium)
- Seebri (glycopyrronium bromide)
- Incruse Ellipta (umeclidinium)
Some of these medicines — such as Arcapta and Serevent Diskus — are also indicated in the treatment of asthma.
New Increased Cardiovascular Risks
A recent study involving over 280,000 patients with COPD suggests that users of LABAs and LAMAs have an increased risk of heart attacks and strokes within the first several weeks of using these medicines.
More specifically, patients who used these medicines experienced a 50% increased risk of a severe cardiovascular event within the first 30 days of use. After that time period, however, the risk declined.
Here is an excerpt from the “Conclusions and Relevance” section of the study’s Abstract:
New initiation of LABAs or LAMAs in patients with COPD is associated with an approximate 1.5-fold increased severe cardiovascular risk, irrespective of prior CVD status and history of exacerbations.
These medicines can put their users at risk of serious cardiovascular events because they:
- accelerate the heart rate;
- construct the blood vessels;
- increase blood pressure; and,
- may also increase inflammation.
Possible Product Label Change
Though he was not part of the study, Dr. Tadahiro Goto, a researcher at Massachusetts General Hospital in Boston, provided the following commentary (excerpted from a recent Reuters article):
Patients should know that their risk for cardiovascular diseases will be increased after initiation of bronchodilators even though the treatment is essential. While patients shouldn’t stop using inhalers, they should be vigilant about seeking medical attention for symptoms that might indicate a heart problem, such as chest pains or a suddenly rapid heart beat.
It is true that patients should be aware of the risks involved with using these medicines. Going forward, it will be interesting to see whether the FDA and other regulatory bodies agree, and mandate that the risk of heart attacks and strokes be added to the product labels for these medicines.
We will continue to monitor the medical and regulatory literature concerning the risk of cardiovascular events due to LABAs and LAMAs, and report on significant events.
Written by: Heather Helmendach, Legal Assistant
Law Offices of Thomas J. Lamb, P.A.
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