Sigurnost primjene simpatomimetika dugog djelovanja (LABA) u bolesnika s astmom zasigurno je jedan od najčešće raspravljanih predmeta u farmakoterapiji ove bolesti tijekom posljednjih dvadesetak godina. Prisutni su stavovi u rasponu od mišljenja o njihovoj potpunoj sigurnosti do prijedloga da budu zabranjeni. Kao moguće posljedice primjene LABE zagovornici njihove štetnosti ističu toleranciju i smanjenu učinkovitost simpatomimetika kratkog djelovanja (SABA). To bi moglo rezultirati gubitkom kontrole astme, povećanom stopom egzacerbacija, a u konačnici i povećanim mortalitetom. Višestruke pažljive, nezavisne i nepristrane analize baza podataka dosadašnjih ispitivanja nisu potvrdile rizičnost propisivanja LABE kada se, sukladno preporukama smjernica, propisuje uz inhalacijske kortikosteroide (ICS). Konačan odgovor trebalo bi dati planirano prospektivno ispitivanje s ciljem usporedbe primjene kombinacije LABE i ICS-a u odnosu prema samom ICS-u. Neki autoriteti ističu da je ovakvo istraživanje neracionalno te da će s obzirom na potrebnu veličinu uzorka biti vrlo skupo, a da precizan odgovor možda neće bit moguć ni nakon njegova završetka. Bilo kako bilo, do objave rezultata tog ispitivanja vrijede višestruko provjereni naputci aktualnih smjernica. Oni dopuštaju propisivanje LABE u liječenju astme samo u kombinaciji s ICS- -om, i to u bolesnika u kojih kontrola astme nije postignuta niskim ili srednje visokim dozama ICS-a. Preporučuje se uporaba fiksnih kombinacija u istom raspršivaču što onemogućuju potencijalno rizično uzimanje same LABE.The safety of long acting beta agonists (LABAs) in asthma patients has been certainly one of the most discussed issues in the pharmacotherapy of this disease over the last twenty years. The opinions range from those favouring their full safety to those suggesting their ban. Those opposing their use claim that LABAs may reduce tolerance and efficiency of SABA. This could lead to the loss of asthma control, increased exacerbation rate, and finally, to increased mortality. Multiple, thorough, independent and unbiased analyses of data obtained by trials so far have not confirmed LABA related risks if used concomitantly with inhaled corticosteroids (ICS) in line with the relevant guidelines. A planned prospective trial, whose aim is to compare the co-administration of LABA and ICS with ICS administered as monotherapy, should give the final answer. Some authorities in this field claim that such a research would be irrational and very expensive due to the requisite sample size. Additionally, they claim that it may not be possible to give a precise answer even after its completion. In any case, the current guidelines, which have been verified on multiple occasions, are valid until the results of this trial become available. The current guidelines allow the administration of LABA in asthma patients in combination with ICS, however, only in those patients whose asthma cannot be controlled by low or moderately high doses of ICS. The use of fixed combinations in the same spray, which would prevent potential risks of LABA used in monotherapy, is therefore recommended
