Episode 954: Combo Rescue Inhalers - New Guidelines

Contributor: Aaron Lessen, MD

Educational Pearls:

What is a Rescue Inhaler?

• A rescue inhaler is a medication for people with asthma to quickly reverse the symptoms of an asthma attack. 

• Historically albuterol (Short Acting Beta Agonist (SABA)) monotherapy has been the mainstay rescue inhaler. This is because albuterol works fast and is relatively cheap. \n\n

What are Combination Rescue Inhalers?

• Combination rescue inhalers contain a fast-acting bronchodilator as well as an inhaled corticosteroid (ICS)

• The steroid helps to reduce some of the chronic airway inflammation that is worsening the asthma attack and can help to prevent future attacks

• Examples include budesonide-formoterol and albuterol-budesonide

• Global Initiative for Asthma (GINA), states that combination therapy is now the preferred reliever for adults and adolescents with mild asthma

What are the drawbacks of Combination Rescue Inhalers? 

• These inhalers are generally more expensive than just using a SABA inhaler which can be a barrier for some people \n\n

• Improper use can also lead to conditions like thrush due to the addition of the steroid 

References 

1. Krings JG, Beasley R. The Role of ICS-Containing Rescue Therapy Versus SABA Alone in Asthma Management Today. J Allergy Clin Immunol Pract. 2024 Apr;12(4):870-879. doi: 10.1016/j.jaip.2024.01.011. Epub 2024 Jan 17. PMID: 38237858; PMCID: PMC10999356. 

2. Papi A, Chipps BE, Beasley R, Panettieri RA Jr, Israel E, Cooper M, Dunsire L, Jeynes-Ellis A, Johnsson E, Rees R, Cappelletti C, Albers FC. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med. 2022 Jun 2;386(22):2071-2083. doi: 10.1056/NEJMoa2203163. Epub 2022 May 15. PMID: 35569035. 

Summarized by Jeffrey Olson, MS3 | Edited by Jorge Chalit, OMS3 \n\n

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