Long-Acting Beta2-Agonists for Long-Term Control of Asthma

Covers medicines used in metered-dose or dry powder inhaler to treat asthma. Lists generic and brand names like budesonide and formoterol (Symbicort) and fluticasone and salmeterol (Advair). Covers how well they work and side effects.

Long-Acting Beta2-Agonists for Long-Term Control of Asthma


Combinations of a long-acting beta2-agonist
and inhaled corticosteroid:

Generic Name Brand Name
formoterol and budesonide Symbicort
formoterol and mometasone Dulera
salmeterol and fluticasone Advair

Long-acting beta2-agonists are used only in combination
with a corticosteroid to treat asthma. They are used in a metered-dose or dry
inhaler. Always read the directions to be sure you are using
the inhaler correctly.

How It Works

Long-acting beta2-agonists
(bronchodilators) relax the smooth muscles lining the airways that carry air to
the lungs (bronchial tubes). This allows the tubes to stay open longer and
makes breathing easier.

Salmeterol takes about 30 minutes to
start to work. It reaches peak effectiveness after 3 to 4 hours and lasts for
more than 12 hours.

Formoterol starts to work within a few minutes. It lasts for more than 12 hours.

Why It Is Used

Long-acting inhaled beta2-agonists
are used on a daily basis to control
moderate and severe persistent asthma. The U.S.
National Asthma Education and Prevention Program (NAEPP) recommends using them
only as an addition to inhaled
corticosteroids.footnote 1 Long-acting
inhaled beta2-agonists enhance the corticosteroids' anti-inflammatory action
for controlling asthma and preventing
asthma attacks. They should not be used as a
substitute for inhaled corticosteroids.

Different types of
medicines are often used together in the treatment of asthma. Medicine
treatment for asthma depends on a person's age, his or her type of asthma, and
how well the treatment is controlling asthma symptoms.

  • Children up to age 4 are usually treated a
    little differently than those 5 to 11 years old.
  • The least amount
    of medicine that controls the asthma symptoms is used.
  • The amount
    of medicine and number of medicines are increased in steps. So if asthma is not
    controlled at a low dose of one controller medicine, the dose may be increased.
    Or another medicine may be added.
  • If the asthma has been under
    control for several months at a certain dose of medicine, the dose may be
    reduced. This can help find the least amount of medicine that will control the
  • Quick-relief medicine is used to treat asthma attacks. But
    if you or your child needs to use quick-relief medicine a lot, the amount and
    number of controller medicines may be changed.

Your doctor will work with you to help find the number and
dose of medicines that work best.

How Well It Works

A review of research found that
in adults with persistent asthma who use inhaled corticosteroids but continue
to have symptoms (poorly controlled asthma), adding long-acting
beta2-agonists:footnote 2

  • Improved symptoms and lung function compared
    with using a corticosteroid only.
  • Improved symptoms and lung
    function and resulted in less use of quick-relief medicine compared with
    increasing the dose of inhaled corticosteroids.
  • Improved lung
    function compared with adding a leukotriene pathway modifier.

A review of research found that in children with
persistent asthma who use inhaled corticosteroids but continue to have symptoms
(poorly controlled asthma), adding long-acting beta2-agonists resulted
in:footnote 3

  • Improved lung function as measured by forced expiratory volume at 1 minute (FEV1).
  • More days free of symptoms (in children 4 to 16 years old).

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Common side effects of this medicine include:

  • Throat irritation and hoarseness (caused by
    inhaled corticosteroids in combination medicines).
  • Rapid heartbeat
  • Headache and
  • Nausea, vomiting, and
  • Anxiety.
  • Nervousness or tremor (such as
    unsteady, shaky hands).

The U.S. Food and Drug Administration (FDA) has reported
that these medicines may make an asthma episode worse and may increase the risk
of death. If your wheezing gets worse after you take this medicine, call your
doctor right away.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Long-acting inhaled
beta2-agonists should not be used without being combined with an inhaled
corticosteroid. If you don't take an inhaled corticosteroid, the
inflammation in the bronchial tubes may not be
controlled, and your symptoms could get worse because of decreasing lung
function and increasing inflammation.

Long-acting inhaled
beta2-agonists should never be used in place of a short-acting beta2-agonist to
treat asthma attacks. A quick-relief medicine such as inhaled albuterol should
be used.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breastfeeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breastfeeding, or planning to get pregnant.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) ( What is a PDF document? ) to help you understand this medication.



  1. National Institutes of Health (2007). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08–5846). Available online: ://www.nhlbi.nih.gov/guidelines/asthma/index.htm.
  2. Dennis RJ, Solarte I (2011). Asthma in adults (chronic), search date April 2010. BMJ Clinical Evidence. Available online: ://www.clinicalevidence.com.
  3. Turner ST, et al. (2012). Asthma and other recurrent wheezing disorders in children (chronic), search date June 2010. BMJ Clinical Evidence. Available online: ://www.clinicalevidence.com.


ByHealthwise StaffPrimary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer Elizabeth T. Russo, MD - Internal Medicine

Current as ofDecember 6, 2017