Long-acting beta-adrenoceptor agonist

Just keep that in mind.

Now, your long-acting beta-2 agonists, or LABA, L-A-B-A, include drugs like salmeterol and formoterol.

Their side chains on the chemical molecule itself are going to actually anchor them in or near the receptor.

So they're going to last a lot longer.

And these are more maintenance drugs.

So if you have somebody that has asthma, the LABA or the long-acting beta agonist pretty much should never be used by itself.

LABA use without some kind of inhaled steroid has actually been linked to fatal or near-fatal asthma attacks.

So in asthma, it's always paired with an inhaled corticosteroid.

Now, the triple therapy shows the three mechanisms here in a table.

In the columns is ICS, LABA, beta agonist, and that mediates relaxation actively by increasing cyclic AMP, or the anticholinergic, which actually blocks the M3 receptor that is found on smooth muscle and glands.

So you can see the ICS has attacked the cytokines and the eosinophils, the beta agonists, and the direct effect on smooth muscle by promoting active bronchorelaxation.

And the LAMA prevents the constriction of the acetylcholine receptor, the M3 receptor.

the upper airways and central airways, whereas the llamas are really focused on the small airways.

Now, the example of agents here in ICS is going to be budesonide or fluticasone.

LABA is going to be from motorol or volantrol.

And the anti-muscarinics could be glycopyrinone or umeclodonium.

This is important for you guys to know, the long-acting beta agonists, LABA, have a black box warning about the increased risk of asthma-related death when patients use these drugs.

The LABAs alone are not recommended for treating asthma.

This right here, this line right here, that is on... that's been seen, I should say, on NCLEX for RN and the boards for NP.

That's very important for you guys to know.

The LABAs, which are the long-acting beta agonists, these are maintenance therapy.

They should not be used alone.

Salmeterol and other LABAs have a greater risk of asthma-related deaths, especially in older adults and African American patients.

The risk is lowered when LABAs are combined with an inhaled corticosteroid.

One of those episodes of treatment gets you a quarter of the way to that lifetime level where researchers start to worry.

And then I noticed here that in the guidelines, it actually talks about if a person is coming in with an acute exacerbation, you're obviously arranging your follow-up and certainly thinking about ICS, LABA treatment.

And we'll get to that maybe in a little bit more when we come to the long-term management in a minute.

And then it certainly talks about in the rural hospital setting, NED, Yosabro plus his steroids, and then adding in plus or minus ibrotropium bromide or IV magnesium sulfate.

Mm-hmm.

When we, when we combine these three treatments together, that is the inhaled corticosteroid, which we call the ICS, the LABA, and the LAMA, we have triple therapy.

And you can provide triple therapy i- either in a single inhaler or, uh, potentially one, two, or three inhalers.

Now, now before we talk about stepping up therapies, what, uh, should clinicians confirm first? For example, is it important to revisit the diagnosis, spirometry, symptom patterns, exacerbation history, maybe even triggers and comorbidities?

Mm.

So then where does triple therapy fit within the guideline context for asthma? For example, which patient profiles may benefit the most, and what should clinicians be trying to improve when it's becoming a consideration?

Well, you would, you'd step a patient up to triple therapy if they were already on regular ICS LABA therapy, that is double therapy-

Okay