Do you use both albuterol (Salbutamol) and Symbicort (Budesonide/Formoterol) as rescue therapy, or only Symbicort (Budesonide/Formoterol) when on a maintenance regimen (Mart)?

From the Guidelines

If you are on MART (Maintenance and Reliever Therapy) with Symbicort, you should use only Symbicort as your rescue therapy, not albuterol. This approach is based on the most recent guidelines and evidence, including the 2020 focused updates to the asthma management guidelines 1, which suggest that individuals aged 12 years and older with mild persistent asthma may benefit from intermittent ICS dosing, and that Symbicort can serve as both a maintenance and rescue medication. The use of Symbicort as a rescue therapy is supported by its formulation, which includes formoterol, a fast-acting bronchodilator similar to albuterol, and budesonide, an anti-inflammatory component that addresses underlying inflammation 1. Using albuterol alongside Symbicort in a MART regimen is unnecessary and may lead to overuse of rescue medication. However, if you're not specifically on a MART regimen but instead using Symbicort only as a maintenance inhaler, then you would use albuterol as your rescue medication. Some key points to consider when using Symbicort as a rescue therapy include:

• Always follow your healthcare provider's specific instructions for your individual treatment plan
• Use Symbicort as needed for asthma symptoms, rather than switching to albuterol
• Be aware of the potential for overuse of rescue medication, and monitor your symptoms and medication use closely
• Regular follow-up with your healthcare provider is essential to ensure that your treatment plan is working effectively and to make any necessary adjustments.

From the FDA Drug Label

The selection of budesonide 80 mcg is supported by a 6-week, randomized, double-blind, placebo-controlled study in 304 pediatric patients (152 budesonide, 152 placebo) 6 to less than 12 years of age with asthma Results showed that budesonide 80 mcg (2 inhalations twice daily) provided statistically significantly greater improvement compared to placebo for the primary endpoint of change from baseline to the treatment period average in pre-dose morning PEF and the key secondary endpoint of change in pre-dose morning FEV1 Reduction in asthma symptoms and in albuterol rescue use, as well as improvement in morning and evening PEF, occurred within 1 day of the first dose of budesonide and formoterol fumarate dihydrate; improvement in these variables was maintained over the 12 weeks of therapy

Rescue Therapy:

• Symbicort is used as a maintenance therapy, and albuterol is used as a rescue therapy.
• If on Symbicort (budesonide and formoterol fumarate dihydrate) maintenance therapy, albuterol can still be used as a rescue therapy.
• The label does not explicitly state to only use Symbicort as rescue therapy, but rather it is used for maintenance and control of asthma symptoms, with albuterol available for rescue use 2

From the Research

Rescue Therapy for Asthma

• The use of a fixed-dose combination of albuterol and budesonide as rescue medication has been shown to reduce the risk of severe asthma exacerbation compared to albuterol alone 3.
• A study found that the risk of severe asthma exacerbation was significantly lower, by 26%, in the higher-dose combination group than in the albuterol-alone group 3.
• Another study explored the potential benefits of substituting SABA with budesonide-formoterol as rescue medication in mild asthma patients, and found that the combination with formoterol-budesonide as rescue medication provides better asthma control than short-acting β-agonists alone 4.

Symbicort as Rescue Therapy

• Symbicort, a combination of budesonide and formoterol, can be used as both maintenance and reliever therapy in asthma management 5.
• The use of Symbicort as maintenance and reliever therapy has been shown to reduce the risk of severe asthma exacerbations compared to conventional regimens using a short-acting beta(2)-adrenoceptor agonist alone as reliever therapy 5.
• A review of the use of budesonide/formoterol as maintenance and reliever inhalation therapy in asthma found that it offers a new approach to therapy in patients with uncontrolled, persistent asthma, providing improved efficacy with a lower overall drug load 5.

Comparison of Albuterol and Symbicort as Rescue Therapy

• A study suggested that using BUD-ALB as AIR therapy can reduce exacerbations, either on its own in mild asthma or in conjunction with fixed-dose maintenance ICS-long-acting beta-agonist in moderate to severe asthma 6.
• Head-to-head clinical studies are indicated to compare BUD-FORM versus BUD-ALB as AIR in mild asthma, and also BUD-FORM as maintenance and reliever therapy versus BUD-ALB as AIR plus maintenance ICS-long-acting beta-agonist in moderate to severe asthma 6.