[Pa23] Asthma information for clarification

[Kesic, Matthew J]

Dear Class,

I have had a few of you asking the same question about asthma medications and Michelle and I wanted to clear a few things up. There have been questions about using albuterol as a rescue inhaler.

Here are the details.

Albuterol has always been the rescue inhaler of choice. Its action of opening up the airway acts very quickly and ends quickly (ideal for a rescue medication).

Many of the maintenance medications are combos (ICS + LABA)

Patients don’t like having 2 different inhalers (rescue and maintenance)

The new guidelines you were hearing about from pharm (SMART therapy) is a push to use the combo medication as the rescue inhaler. This would eliminate the need for 2 inhalers.

Here is the catch…..Not just any combo inhaler (ICS + LABA) can be used!

What you need to know is the beta-agonist medication.

Albuterol acts quickly and ends quickly.

Salmeterol takes a long time to act but lasts a long time once it starts working, making it a great LABA to be used in combination with an inhaled steroid (Advair is the standard here).

Formoterol has the best of both worlds. Recent studies showed that formoterol does have the ability to both act quick and lasts a long time. This is why the guidelines say you can use this formulation as both a rescue medication and as a maintenance medication.

Please take note Symbicort (budesonide and formoterol) is the only combo that is approved for SMART therapy and this is only in the guidelines for ages 5 and up for moderate or severe persistent asthma (this is not in guidelines for mild asthma).

Advair (fluticasone / salmeterol) is not used as a recuse inhaler!

This is why albuterol is still the main standard for rescue medication and is used routinely for asthma exacerbations/attacks.  In emergency care settings (urgent care, primary care office for sick visit, ER), we use albuterol!

I hope this helped a little. As always feel free to contact me with any questions. Good luck studying and best of luck on Monday!

Drs. Kesic & Hernandez

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