Authors:
Katherine Montag Schafer, PharmD, BCACP, CDCES
Stefanie C. Nigro, PharmD, BCACP, CDCES
Reviewers:
Kristen Pate, PharmD, BCACP
Margaret Miklich, PharmD, BCACP
Citation:
Papi A, Chipps BE, Beasley R, et al. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med 2022; 386(22): 2071-2083.
The Problem
It is well established that overuse of short-acting beta-agonists (SABA) increases the risk of poor asthma control, exacerbations, and mortality. Why? Because they do not address the underlying airway inflammation that is the root cause of asthma.1 Despite these data, reliance on SABA has remained the standard of care for rescue therapy … until recent clinical practice guideline updates, which now recommend alternative rescue regimens in some or most patient populations.2-4 Several studies have used alternative rescue treatment regimens that combine both a beta-agonist with an inhaled corticosteroid (ICS). The combination provides relief of symptoms and decreases the risk of poor outcomes.5-9While the majority of these studies provide evidence to support single maintenance and reliever therapy (SMART) with ICS-formoterol, there is still a need to identify other combination rescue regimens to broaden treatment options and reduce barriers to access (e.g., cost and insurance coverage) as well as patient reluctance to change.
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Thank you for the informative, relevant podcast on asthma guidelines and studies. I work as a Transitions of Care Pharmacist in a small, rural hospital in Johnson City, New York. I still see albuterol HFA inhalers used as the dominant rescue inhaler in patient’s asthma regimens. In many cases, patients tell me they were never told the risks of overusing their albuterol inhalers and haven’t yet figured out what maintenance inhaler they can afford. I run test claims with their insurance using EPIC and recommend appropriate SMART therapy options. I find most insurance plans cover either Dulera or brand name Symbicort.