From the Guidelines
Short-acting beta-agonist (SABA) inhalers, particularly albuterol, are the best choice for immediate relief of wheezing. The standard dose is 1-2 puffs (90-180 mcg) every 4-6 hours as needed, though during acute episodes, it can be used more frequently under medical supervision 1. Albuterol works by relaxing the smooth muscles in the airways, which opens them up and allows for easier breathing within minutes of use. Other SABA options include levalbuterol (Xopenex), which some patients may tolerate better with fewer side effects.
These rescue inhalers should be carried at all times by people with asthma or other conditions that cause wheezing. While they provide quick relief, frequent use (more than twice weekly) suggests poor control of the underlying condition and should prompt consultation with a healthcare provider about adjusting controller medications 1. Side effects may include tremors, increased heart rate, and nervousness, but these are typically mild and temporary. It's also worth noting that albuterol has an excellent safety profile, especially during pregnancy, making it a preferred choice in such cases 1.
Some key points to consider when using SABA inhalers for wheezing include:
- Using them only as needed for relief of symptoms or before anticipated exposure to known asthmatic triggers
- Taking puffs in 10- to 15-second intervals, as longer intervals offer no benefits
- Being aware that regular use does not affect potency but is associated with a reduction in the duration of action
- Consulting a healthcare provider if frequent use is necessary, as this may indicate a need for adjusting controller medications.
From the FDA Drug Label
As with other inhaled asthma medications, bronchospasm, with an immediate increase in wheezing, may occur after dosing. If acute bronchospasm occurs following dosing with budesonide inhalation suspension, it should be treated immediately with a fast-acting inhaled bronchodilator.
The best inhaler for immediate relief of wheezing is a fast-acting inhaled bronchodilator, not budesonide inhalation suspension, as it may cause bronchospasm with an immediate increase in wheezing. Budesonide inhalation suspension is not indicated for immediate relief of wheezing, but rather for long-term control of asthma symptoms 2.
- Key points:
- Budesonide inhalation suspension may cause bronchospasm with an immediate increase in wheezing.
- A fast-acting inhaled bronchodilator should be used for immediate relief of wheezing.
- Budesonide inhalation suspension is not indicated for immediate relief of wheezing.
From the Research
Inhalers for Wheezing
Inhalers are a common treatment for wheezing, which is often associated with asthma and chronic obstructive pulmonary disease (COPD). The best inhaler for immediate relief of wheezing depends on several factors, including the severity of symptoms and the individual's medical history.
Types of Inhalers
- Short-acting beta-agonists (SABAs), such as salbutamol and fenoterol, provide quick relief from wheezing and are used as needed 3
- Long-acting beta-agonists (LABAs), such as salmeterol and formoterol, provide longer-lasting relief and are used twice daily 3, 4, 5
- Combination inhalers, which combine a LABA with an inhaled corticosteroid (ICS), such as fluticasone/salmeterol and budesonide/formoterol, may be more effective for some individuals 6
Characteristics of Effective Inhalers
- Rapid onset of action, such as formoterol, which has a faster onset of action compared to salmeterol 3, 5
- Long duration of action, such as indacaterol, which has a 24-hour duration of action 3
- High potency and selectivity for beta(2)-adrenoceptors, such as salmeterol and formoterol 3, 4, 7
Important Considerations
- Patients should be educated on the proper use of inhalers, including the importance of using them regularly and as directed 7
- Combination therapy with an ICS and a LABA may be more effective for some individuals, but the risk of pneumonia should be carefully considered 3
- Ultra-LABA/long-acting muscarinic receptor antagonist (LAMA) combination treatment is under development and may become a standard treatment for COPD 3