@article{gupta2015addition,
  title = {Addition of LABA to Low dose  ICS in asthma-Is it justified?},
  author = {Prahlad Rai  Gupta},
  year = 2015,
  url = {https://ibimapublishing.com/articles/RESP/2015/386193/},
  journal = {Journal of Respiratory Medicine Research and Treatment},
  volume = 2015 (2015),
  pages = 10,
  doi = 10.5171/2015.386193,
  abstract = {Most current guidelines to treat asthma recommend low dose inhaled corticosteroids (ICS) along with long acting β2 agonists (LABA) during step 3 and reduction in dose of ICS first (rather than stopping LABA) during step down. This has led to widespread use of LABA with low dose ICS, more so in fixed dose formulations. Since optimal dose of ICS in the initiation phase is not clearly defined and the safety of regular use of LABA with low dose ICS continues to be debatable, the rationale for use of fixed dose formulations of LABA with low dose ICS, needs to be re-assessed. The author has perused the current experimental and clinical data on ICS and LABA and is of the opinion that starting treatment with LABA and higher dose of ICS leads to better control of asthma in terms of clinical response, pulmonary functions, airway hyper reactivity (AHR) and surrogate markers of inflammation as compared to LABA with low dose ICS. Further, in the eye of the author, withdrawal of LABA first and subsequent lowering the dose ICS upon achieving persistent control should be more appropriate as compared to lowering the dose of ICS first and continuing LABA during step down. That being so, fixed dose formulations of LABA and low dose ICS should not find any place in the management of Chronic persistent bronchial asthma (CPBA).},
  keywords = {Chronic persistent bronchial asthma, long acting b2 agonists, Inhaled corticosteroids, Low dose ICS-LABA fixed dose formulations.},
  note = Article ID: 386193
}