From the Guidelines
I strongly recommend adding a long-acting inhaled beta2-agonist to a low-to-medium dose of inhaled corticosteroids as the next step in managing your asthma, as the albuterol rescue inhaler alone is not providing adequate symptom control. According to the most recent and highest quality study 1, this is the preferred treatment for moderate persistent asthma. Before making any changes, it's essential to review your inhaler technique and adherence to ensure you're using the medication correctly. Additionally, identifying and addressing any environmental factors that may be contributing to your worsening asthma is crucial.
Some key points to consider when adding a new medication to your treatment plan include:
- Proper inhaler technique: inhale slowly and deeply, hold your breath for 10 seconds, and rinse your mouth after using corticosteroid inhalers to prevent thrush
- Starting with a low-to-medium dose of inhaled corticosteroids, such as fluticasone (Flovent) 110-220 mcg twice daily or budesonide (Pulmicort) 180-360 mcg twice daily
- Adding a long-acting beta-agonist (LABA) like a fluticasone/salmeterol combination (Advair) or budesonide/formoterol (Symbicort) if symptoms persist after 2-4 weeks on an ICS
- Continuing to use your albuterol inhaler as needed for breakthrough symptoms, but with proper controller medication, you should need it less frequently
It's essential to schedule a follow-up appointment with your healthcare provider to assess your response to the new treatment plan and make any necessary adjustments. By working together, you can find the right combination of medications to manage your asthma and improve your quality of life.
From the FDA Drug Label
If a previously effective dosage regimen fails to provide the usual relief, medical advice should be sought immediately, as this is often a sign of seriously worsening asthma that would require reassessment of therapy. The patient's albuterol rescue inhaler is no longer helping, which may indicate worsening asthma.
- Medical advice should be sought immediately to reassess the patient's therapy 2.
- The current treatment regimen may need to be adjusted or alternative treatments considered to manage the patient's asthma effectively.
From the Research
Asthma Treatment Options
- The patient's current treatment with an albuterol rescue inhaler is not providing sufficient relief, indicating a need to reassess their treatment plan 3.
- Studies have shown that combining inhaled corticosteroids (ICS) with long-acting β2-agonists (LABA) can provide better asthma control than using short-acting β-agonists (SABA) alone 4, 5, 6.
Alternative Treatment Approaches
- The use of ICS-LABA as a rescue medication has been explored in several studies, with results showing that it can provide better asthma control than SABA alone in mild asthma patients 3.
- However, the evidence for using ICS-LABA as a replacement for chronic ICS in GINA step 2 patients is limited, and more research is needed to fully understand its effectiveness 3.
Treatment Interval for Albuterol
- A study on the emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber found that treatments can be administered optimally at 60-min intervals with minimal adverse effects for the majority of patients 7.
- However, patients who initially demonstrate a low or poor bronchodilator response to albuterol may benefit from more frequent treatments at 30-min intervals 7.
Factors Affecting Asthma Control
- Age, obesity, and smoking have been identified as factors that can negatively affect disease control in patients using combined ICS/LABA inhalers 4.
- These factors may need to be taken into account when developing a treatment plan for the patient.