What is the first line inhaler for intermittent asthma in New Zealand?

From the Guidelines

The first-line inhaler for intermittent asthma in New Zealand is a short-acting beta-agonist (SABA) such as salbutamol (Ventolin, Respigen, or Salamol). This recommendation is based on the most recent and highest quality study available, which suggests that SABAs are the preferred treatment for mild intermittent asthma 1. The standard dose is 1-2 puffs (100-200 micrograms) when required for symptom relief, with a maximum of 12 puffs per 24 hours in adults. For children, the dose is typically 1-2 puffs as needed, with adjustments based on age and weight.

Some key points to consider when prescribing a SABA for intermittent asthma include:

• Patients should carry their salbutamol inhaler with them at all times for quick relief of asthma symptoms such as wheezing, chest tightness, or shortness of breath.
• Salbutamol works by relaxing the smooth muscles in the airways, causing bronchodilation and allowing easier breathing within minutes of administration.
• If a patient needs to use their reliever inhaler more than twice a week, this indicates poor asthma control, and they should consult their healthcare provider about possibly adding a preventer medication to their regimen.
• The 2020 focused updates to the asthma management guidelines suggest that individuals aged 12 years and older with mild persistent asthma may benefit from intermittent ICS dosing, but this is not recommended for children aged 0 to 4 years or 5 to 11 years with mild persistent asthma due to insufficient evidence 1.

It's worth noting that while older studies such as the 2005 NAEPP expert panel report also recommend SABAs as the first-line treatment for intermittent asthma 1, the most recent and highest quality study available is the 2020 focused updates to the asthma management guidelines 1. Therefore, this study is given priority when making recommendations for the treatment of intermittent asthma in New Zealand.

From the FDA Drug Label

The active component of albuterol sulfate inhalation aerosol is albuterol sulfate, USP racemic α1 [(tert-Butylamino)methyl]-4-hydroxy-m-xylene-α,α'-diol sulfate (2:1)(salt), a relatively selective beta2-adrenergic bronchodilator Albuterol sulfate inhalation aerosol is a pressurized metered-dose aerosol unit for oral inhalation

The first line inhaler for intermittent asthma in New Zealand is salbutamol.

• Key points:
  • Salbutamol is a relatively selective beta2-adrenergic bronchodilator.
  • It is used for oral inhalation.
  • Each actuation delivers 120 mcg albuterol sulfate from the valve and 108 mcg albuterol sulfate from the mouthpiece.
  • The product does not contain chlorofluorocarbons (CFCs) as the propellant 2, 2.

From the Research

First Line Inhaler for Intermittent Asthma in New Zealand

• The first line treatment for intermittent asthma is typically inhaled salbutamol used on demand to relieve respiratory discomfort or to prevent attacks due to a known trigger 3.
• However, for patients with persistent asthma, a combination of inhaled salbutamol and an inhaled corticosteroid such as beclometasone may be used on a daily basis 3.
• Combination inhalers containing inhaled corticosteroids and long-acting beta2-agonists, such as budesonide/formoterol and salmeterol/fluticasone, have been shown to be effective and well tolerated in asthma treatment 4, 5.
• These combination inhalers can simplify treatment and improve asthma control, and may be used for maintenance and as needed for symptom relief 4, 5.
• The use of combination inhalers as a reliever therapy has been proposed as a novel approach for the treatment of intermittent and mild asthma, with the potential to enhance inhaled corticosteroid use in poorly adherent patients 6.