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From the Allergy, Asthma, and Immunology Section in the Departments of Medicine and Pediatrics, Penn State University Milton S. Hershey Medical Center, Hershey.

Address correspondence to Timothy J. Craig, DO, Allergy, Asthma, and Immunology Section, Penn State University Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033-2360. E-mail: tcraig{at}psu.edu

Inhaled corticosteroids are the mainstay of asthma therapy; however, inhaled long-acting ß2-agonists (LABAs) are frequently used in the treatment of patients with asthma. LABAs are combined with high-dose inhaled corticosteroids (ICSs) for patients with severe persistent asthma, and they are combined with low-dose ICSs for patients older than 5 years with moderate persistent asthma. Recent safety concerns raised by data from the Salmeterol Multi-Center Research Trial (SMART) have indicated that use of LABAs in some populations may contribute to increased mortality. These concerns are warranted when LABAs are used as monotherapy in the treatment of patients with asthma in whom they may cause increased exacerbations, blunting of rescue-medication effect, and worsening symptoms. However, when used in combination with an ICS, they decrease both rescue-medication use and symptoms, increase lung function, and act as steroid-sparing agents.