What is the genetic name for a SABA (Short-Acting Beta Agonist)-ICS (Inhaled Corticosteroid) inhaler?

Generic Names for SABA-ICS Inhalers

The generic names for SABA-ICS combination inhalers include albuterol-budesonide, which is the only currently available SABA-ICS combination inhaler.

Background on SABA-ICS Combinations

SABA (Short-Acting Beta Agonist) and ICS (Inhaled Corticosteroid) combinations represent a relatively new approach in asthma management. Traditionally, asthma medications have been divided into:

1. Controller medications (primarily ICS, sometimes combined with LABA)

   • Inhaled corticosteroids (ICS): budesonide, fluticasone, beclomethasone, mometasone, ciclesonide, triamcinolone 1
   • Long-acting beta agonists (LABA): salmeterol, formoterol, vilanterol 1

2. Reliever medications (primarily SABA)

   • Short-acting beta agonists (SABA): albuterol (salbutamol), levalbuterol, terbutaline, pirbuterol 1

Available SABA-ICS Combinations

Until recently, there were no approved SABA-ICS combination inhalers. The 2020 GINA guidelines 1 mention this approach as an emerging option:

• "Low-dose ICS taken whenever SABA is taken" is listed as an "other controller option" in the stepwise approach
• This was initially implemented using separate inhalers

The only currently available SABA-ICS combination in a single inhaler is:

• Albuterol-budesonide (generic names)

Clinical Context and Importance

The SABA-ICS combination approach represents a paradigm shift in asthma management, particularly for mild asthma. Recent evidence supports this approach:

• The Cochrane review 2 found that FABA (Fast-Acting Beta Agonist)/ICS as-needed reduced exacerbations requiring systemic steroids compared to FABA alone (high-certainty evidence)
• This approach may help address poor adherence to regular ICS therapy, which is common in mild asthma and increases risk of exacerbations 3, 2

Important Considerations

1. Not to be confused with LABA-ICS combinations which include:

   • Salmeterol-fluticasone 4, 5
   • Formoterol-budesonide 6
   • Vilanterol-fluticasone furoate 7

2. Safety considerations:

   • Unlike LABAs, SABAs are not associated with the same safety concerns when used without ICS 1
   • The addition of ICS to SABA helps address the underlying inflammation even in intermittent use 3, 2

3. Appropriate patient selection:

   • Most appropriate for patients with mild asthma who may not adhere to daily ICS therapy
   • Not appropriate for primary treatment of status asthmaticus or other acute severe episodes 4

The SABA-ICS approach represents an evolution in asthma management that acknowledges the importance of treating inflammation even during symptom-driven therapy in mild asthma.