title: Update on ultra-long-acting β agonists in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  For the last two decades, long-acting β agonists (LABAs) have been a cornerstone in the management of chronic obstructive pulmonary disease (COPD). They relax airway smooth muscle and augment expiratory airflow, which reduces hyperinflation and improves dyspnea, functional capacity and quality of life. In recent years, Indacaterol, a LABA with an ultra-long duration of action (ultra-LABA), which only requires once-daily dosing, was approved by the FDA. The clinical efficacy of indacaterol is comparable, and, in some aspects better, than the currently available LABAs.
  
  
  METHODS
  This article reviews the pharmacological properties, clinical efficacy, safety and potential role of the ultra-LABAs in COPD management.
  
  
  CONCLUSIONS
  Ultra-LABAs are effective bronchodilators with a prolonged duration of action. By decreasing dosing frequency, ultra-LABAs potentially may improve respiratory medication adherence, which is associated with better survival and less healthcare utilization. In addition to their salubrious benefits, β agonists may produce untoward effects. Increased mortality and hospitalizations among patients with left ventricular heart failure, who were treated with β agonists, has caused concern about their use in patients with COPD and heart disease. Further experience and testing will determine the optimal role of ultra-LABAs in the management of COPD.
authors.affiliation: University of Cincinnati Medical Center, Division of Pulmonary and Critical Care Medicine , 1 Albert Sabin Way, MSB Room 6053, Mail Location 0564, Cincinnati, OH 45267 , USA.
authors.forename: Muhammad Ahsan
authors.initials: MA
authors.lastname: Zafar
authors.forename: Christopher
authors.initials: C
authors.lastname: Droege
authors.forename: Madeline
authors.initials: M
authors.lastname: Foertsch
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Panos
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents
keywords: chronic obstructive pulmonary disease; long-acting β agonist; ultra-long-acting β agonist; β agonist