From the Guidelines
Reactive airway disease should be treated with a combination of short-acting bronchodilators and inhaled corticosteroids, with the addition of long-acting beta2-agonists for persistent symptoms, as recommended by the most recent guidelines 1.
Symptoms of Reactive Airway Disease
The symptoms of reactive airway disease include:
- Wheezing
- Coughing
- Shortness of breath
- These symptoms are similar to those of asthma and are caused by the inflammation and narrowing of the airways in response to certain triggers.
Treatment Options
Treatment for reactive airway disease typically involves:
- Short-acting bronchodilators like albuterol (2 puffs every 4-6 hours as needed) to quickly open airways during symptoms
- Inhaled corticosteroids like fluticasone (1-2 puffs twice daily) to reduce inflammation
- For persistent symptoms, the addition of long-acting beta2-agonists to inhaled corticosteroids is recommended, as stated in the guidelines 1
- Avoiding triggers is essential, and these commonly include smoke, strong odors, cold air, exercise, allergens, and respiratory infections.
Management of Reactive Airway Disease
During an acute episode, it is essential to:
- Remain calm
- Use prescribed rescue medications
- Seek emergency care if symptoms worsen or don't improve
- The condition occurs because irritants cause bronchial smooth muscles to contract and airways to produce excess mucus, leading to the characteristic narrowing and obstruction of airflow.
- Unlike chronic asthma, reactive airway disease may be temporary, often following a respiratory infection, but can develop into persistent asthma in some cases, highlighting the importance of proper management and treatment, as suggested by the guidelines 1.
From the FDA Drug Label
The Salmeterol Multicenter Asthma Research Trial (SMART) A 28-week, placebo-controlled, U.S. trial that compared the safety of salmeterol with placebo, each added to usual asthma therapy, showed an increase in asthma-related deaths in subjects receiving salmeterol (13/13,176 in subjects treated with salmeterol versus 3/13,179 in subjects treated with placebo; relative risk: 4.37 [95% CI: 1.25,15. 34]). Serious acute respiratory events, including fatalities, have been reported when salmeterol, a component of Wixela Inhub®, has been initiated in patients with significantly worsening or acutely deteriorating asthma. Increasing use of inhaled, short-acting beta2-agonists is a marker of deteriorating asthma. Acute symptoms should be treated with an inhaled, short-acting beta2-agonist.
The symptoms of reactive airway disease (RAD) may include increasing use of inhaled, short-acting beta2-agonists, deteriorating asthma, and serious acute respiratory events. Treatment options for RAD may include:
- Inhaled, short-acting beta2-agonists for acute symptoms
- Systemic corticosteroids for severe cases
- Reevaluation of the treatment regimen with possible replacement of the current strength of Wixela Inhub with a higher strength, adding additional ICS, or initiating systemic corticosteroids 2
From the Research
Symptoms of Reactive Airway Disease (RAD)
- Symptoms of RAD can be similar to those of asthma, including wheezing, coughing, and shortness of breath 3
- Severe symptoms may persist despite treatment with bronchodilators and corticosteroids 3
Treatment Options for RAD
- Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are commonly used to treat RAD, as they can help reduce inflammation and improve lung function 4, 5, 6, 7
- Combination therapy with ICS and LABA has been shown to be effective in reducing exacerbations and improving quality of life in patients with chronic obstructive pulmonary disease (COPD) and asthma 4, 5, 6, 7
- Nebulized lidocaine has been used as an alternative therapy for RAD in some cases, particularly when patients are unresponsive to other treatments 3
- Anti-leukotrienes (LTRA) may also be considered as add-on therapy to ICS, although LABA may be more effective in reducing exacerbations and improving lung function 6
Benefits and Risks of Treatment Options
- Combination therapy with ICS and LABA can provide additional benefits over monocomponent therapy, including improved lung function and reduced exacerbations 4, 5, 6, 7
- However, combination therapy may also increase the risk of pneumonia in patients with COPD 5
- LABA may increase the risk of serious adverse events, including asthma-related deaths, particularly when used alone without ICS 4, 6
- LTRA may be associated with a lower risk of serious adverse events compared to LABA, but may be less effective in reducing exacerbations and improving lung function 6