From the Guidelines
For a patient with a 20-year asthma history who is currently using only albuterol but experiencing daily tight breathing and difficulty with powder inhalers, I recommend switching to a non-powder daily controller medication such as Qvar RediHaler (beclomethasone dipropionate) or Alvesco (ciclesonide) as the most effective way to control symptoms and improve quality of life 1. The patient's current reliance on albuterol, a short-acting beta2-agonist, indicates the need for a controller medication to reduce airway inflammation and prevent symptoms.
- Qvar RediHaler and Alvesco are both inhaled corticosteroids delivered via a metered-dose inhaler (MDI) with a propellant, making them easier to use for patients who struggle with dry powder inhalers.
- The typical starting dose would be Qvar 40-80 mcg twice daily or Alvesco 80-160 mcg once daily, as recommended by guidelines 1.
- These medications work by reducing airway inflammation, which is the underlying cause of asthma symptoms, rather than just treating symptoms as albuterol does.
- Using a controller medication daily should reduce the need for rescue albuterol and improve overall symptom control, as supported by expert panel reports 1. When using these inhalers, proper technique is important - breathe out fully before placing the inhaler in your mouth, press to release the medication while taking a slow, deep breath, and hold your breath for 10 seconds afterward.
- A spacer device can also be used to improve medication delivery if coordination is difficult, as recommended by guidelines 1.
From the FDA Drug Label
Adults and Children 2 to 12 Years of Age: The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol (one vial) administered three to four times daily by nebulization. The use of albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm
The patient is looking for a non-powered daily inhaler to help control symptoms. Albuterol is currently being used, but it is powered and causing issues.
- The provided drug label does not mention a non-powered alternative.
- It does mention that albuterol can be used to control recurring bouts of bronchospasm, but it does not provide information on a daily, non-powered inhaler.
- The label recommends seeking medical advice if a previously effective dosage regimen fails to provide the usual relief, as this may be a sign of worsening asthma 2. The FDA drug label does not answer the question.
From the Research
Asthma Treatment Options
- The patient is currently using albuterol, a short-acting beta2-agonist, but is experiencing difficulties with the powdered form and is seeking a non-powdered daily inhaler to control symptoms 3, 4, 5.
- Studies have shown that combination therapy with inhaled corticosteroids and long-acting beta2-agonists is effective in patients with persistent asthma 3, 4, 6, 5.
- Salmeterol/fluticasone propionate is a combination inhaler that has been shown to be effective in improving lung function and symptoms in patients with asthma 3, 4, 5.
- Fluticasone/formoterol fumarate is another combination inhaler that has been approved for the treatment of persistent asthma in patients ≥12 years of age requiring combination ICS-LABA therapy 6.
Non-Powdered Inhaler Options
- Salmeterol/fluticasone propionate is available in a metered-dose inhaler (MDI) form, which may be a suitable alternative for patients who have difficulty with powdered inhalers 4, 5.
- Fluticasone/formoterol fumarate is also available in a pressurized metered-dose inhaler form 6.
- The patient may benefit from consulting with a healthcare professional to determine the best treatment option for their specific needs 7.