From the Research
No, Supra (levalbuterol) should not be used as a rescue medication for a patient on Trelegy for asthma maintenance. Trelegy already contains vilanterol, which is a long-acting beta-agonist (LABA), and adding Supra (another beta-agonist) could potentially lead to dangerous additive effects including increased heart rate, tremors, and other cardiovascular side effects. For rescue medication in patients using Trelegy, a short-acting beta-agonist (SABA) like albuterol (ProAir, Ventolin, Proventil) is the appropriate choice. Albuterol should be used at the standard dosage of 2 puffs every 4-6 hours as needed for acute symptoms. The reason for this recommendation is that albuterol has a different duration of action than the components in Trelegy, making it safer to use for breakthrough symptoms. Patients should be instructed to seek medical attention if they find themselves needing their rescue inhaler more than 2-3 times per week, as this indicates their asthma may not be adequately controlled on their current maintenance therapy. This recommendation is based on the most recent and highest quality studies, including those that have evaluated the safety and efficacy of single-inhaler triple therapy for asthma maintenance 1, 2, 3. While these studies have primarily focused on the use of fluticasone furoate, umeclidinium, and vilanterol for maintenance therapy, they provide valuable insights into the management of asthma and the importance of selecting appropriate rescue medications to minimize the risk of adverse effects and optimize patient outcomes. In contrast, older studies have compared the efficacy and safety of umeclidinium/vilanterol with fluticasone propionate/salmeterol in patients with COPD 4, but these findings are not directly applicable to the use of Supra as a rescue medication in patients with asthma who are taking Trelegy. Therefore, based on the available evidence and considering the potential risks and benefits, albuterol is the preferred rescue medication for patients on Trelegy for asthma maintenance.