Inhaled corticosteroid and long-acting beta agonist (ICS-LABA) inhalers

What is an ICS-LABA inhaler?

These inhalers have a combination of two medicines used together for long-term asthma control, preventing symptoms such as shortness of breath, coughing or wheezing. They are commonly known as controllers. An ICS-LABA inhaler may be prescribed to your child after an asthma attack or an increase in asthma symptoms as a “step-up” therapy to prevent future symptoms.

• Inhaled corticosteroids (ICS) are commonly known as steroids, and they reduce swelling in the airway of the lungs.
• Long-acting beta agonist (LABA) are bronchodilators, which means they relax the muscles in the airway. This allows the airway to open and makes it easier to breathe.

Some examples of ICS-LABA inhalers are:

• budesonide/formoterol (Symbicort)
• fluticasone/salmeterol (Advair)
• mometasone/formoterol (Zenhale)
• mometasone/indacaterol (Atectura)

These medications are given in either a metered-dose inhaler (MDI) or a dry-powder inhaler (Turbuhaler or Diskus).

Tell your child’s health-care provider if your child has:

• allergies to one of the active ingredients (such as fluticasone, mometasone, budesonide, formoterol, salmeterol or indacaterol) or to any of the inactive ingredients in the product

Talk with your child’s health-care provider if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has:

• an infection, such as chickenpox, measles or tuberculosis 
• eye disorders, such as cataracts or glaucoma
• heart problems, such as irregular heart rate or rhythm
• high blood pressure
• severe liver disease
• overactive thyroid (hyperthyroidism)
• weak bones or low bone density (osteopenia)

How should you give your child the ICS-LABA inhaler?

• Give your child the ICS-LABA inhaler exactly as your child’s health-care provider tells you, even if your child seems better.
• Give the ICS-LABA inhaler at the same time(s) every day, unless it is being used as a rescue inhaler for worsening asthma symptoms.
• Do not suddenly stop giving this medicine to your child, even if they start to feel better. Talk with your child's health-care provider before you stop giving this medicine for any reason.
• After each use, have your child rinse their mouth with water and spit out. They should try not to swallow the water.
• For more information, please see the videos below.

How to take your puffer with a spacer and mask

How to take the diskus inhaler

How to use your Turbuhaler

What should you do if your child misses a dose?

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

How long does this medicine take to work?

• It may take several weeks for your child’s asthma symptoms to improve after starting an ICS-LABA inhaler as a controller medication.
• For patients using Symbicort as a reliever medication:
• Your child should begin to breathe easier five to 10 minutes after taking Symbicort.

What are the possible side effects of the ICS-LABA inhaler?

Your child may have some of these side effects while they take an ICS-LABA inhaler.

Check with your child's health-care provider if your child continues to have any of these side effects, if they do not go away or if they bother your child:

• Dry/sore mouth or throat
• Hoarse voice
• Hard time falling asleep or inability to sleep
• Headache
• Bad taste in the mouth

Call your child’s health-care provider during office hours if your child has any of these side effects:

• White spots in the mouth and/or on the tongue (a yeast infection, known as thrush)
• Signs of an infection such as fever, chills, sore throat, cough, etc.
• Feeling a fast heartbeat or like their heart is racing
• Feeling nervous, restless, anxious and/or shaky

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's health-care provider right away or take your child to the nearest Emergency Department if your child has any of these side effects:

• Signs of an allergic reaction such as tightness in chest, inability to breathe, wheezing, rash, hives, trouble swallowing, and/or swelling of the mouth, face, lips or tongue
• If your child is unable to get their asthma symptoms under control

What safety measures should you take when your child is using this medicine?

Not all ICS-LABA inhalers can be used to stop an asthma attack (only Symbicort can be used in some patients). In all other cases, your child should use their reliever medicine.

These warning signs could indicate that your child’s asthma symptoms are getting worse and that your child should be seen by a health-care provider:

• Symptoms such as coughing, wheezing, chest tightness or shortness of breath become more frequent.
• Your child wakes up in the middle of the night with chest tightness, wheezing, shortness of breath or coughing fits.
• Your child misses school or cannot participate in activities because of asthma symptoms.

What other important information should you know about ICS-LABA inhalers?

• Keep a list of all medications your child is on and show the list to the health-care provider.
• Do not share your child’s medicine with others and do not give anyone else’s medicine to your child.
• Make sure you always have enough ICS-LABA inhaler doses to last through weekends, holidays and vacations. Most products have a dose counter on the side of the device that will tell you how many doses are remaining. Call your pharmacy at least two days before your child runs out of medicine to order refills.
• Keep all appointments at the clinic or health-care provider’s office so that they can check your child's reaction to their inhaler and how well their asthma is controlled.
• Keep ICS-LABA inhalers at room temperature in a cool, dry place away from sunlight. Do NOT store them in the bathroom or kitchen.
• For MDI products: Do not store near heat (stoves, hot water, radiator, etc.) as the inhaler/puffer may explode if heated. Do not put holes in the metal part of the puffer. The contents are under pressure.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.

Keep ICS-LABA inhalers out of your child’s sight and reach and locked up in a safe place. If your child takes too much ICS-LABA inhalers, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.