What is the first line inhaler for bronchospasm (reactive airway disease) from viral infection?

From the Guidelines

For reactive airway disease triggered by viral infections, a short-acting beta-agonist (SABA) such as albuterol (also known as salbutamol) is the first-line inhaler treatment. The typical dosage is 2 puffs (90 mcg per puff) every 4-6 hours as needed for wheezing, coughing, or shortness of breath, as suggested by guidelines for managing asthma symptoms 1. For children, the dosage may be adjusted based on weight and age. Albuterol works quickly by relaxing the smooth muscles in the airways, providing relief within minutes by binding to beta-2 receptors and increasing cyclic AMP, which leads to bronchodilation.

During acute viral-induced symptoms, patients may need to use the inhaler more frequently, but should seek medical attention if they require it more than every 4 hours consistently. A spacer device is recommended, especially for children, to improve medication delivery to the lungs. Proper technique involves shaking the inhaler, exhaling fully, placing the mouthpiece between lips, inhaling slowly while activating the inhaler, holding breath for 10 seconds, and waiting 1 minute between puffs. If symptoms persist beyond the viral illness or worsen despite treatment, medical evaluation is necessary as additional medications like inhaled corticosteroids might be needed. It's also important to monitor the use of beta2-agonist drugs, as patients using more than one canister per month may need an increase in daily long-term control therapy 1.

Key considerations for treatment include:

• Monitoring the frequency of inhaler use to assess the need for additional therapy
• Ensuring proper inhaler technique to maximize medication delivery
• Adjusting treatment based on symptom severity and patient response
• Considering the potential need for long-term control medications if symptoms persist or worsen over time. The most recent guidelines support the use of SABA as the first line of treatment for reactive airway disease triggered by viral infections, making it the preferred choice for initial management 1.

From the FDA Drug Label

Albuterol sulfate inhalation solution is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm. The first line inhaler for reactive airway disease from viral infection is albuterol (INH), as it is indicated for the relief of bronchospasm in patients with reversible obstructive airway disease, which can be caused by viral infections 2.

• Key points:
  • Indication: Relief of bronchospasm
  • Patient age: 2 years and older
  • Condition: Reversible obstructive airway disease and acute attacks of bronchospasm

From the Research

First Line Inhaler for Reactive Airway Disease from Viral Infection

• The first line inhaler for reactive airway disease from viral infection is often an inhaled corticosteroid (ICS) in combination with a long-acting beta-adrenergic agonist (LABA) 3.
• ICS therapy forms the basis for treatment of asthma of all severities, improving asthma control, lung function, and preventing exacerbations of disease 3.
• The addition of LABA therapy with ICS increases the efficacy of ICS effects in moderate-to-severe asthma, with a reduction in severe exacerbation rates of up to 63% 3.
• Studies have shown that ICS/LABA combinations, such as fluticasone propionate/salmeterol and budesonide/formoterol, can improve peripheral airway function in mild persistent asthma within 5 minutes of administration 4.
• However, the use of ICS can also have local side effects, such as oral candidiasis, hoarseness, and dysphonia, as well as systemic side effects, such as easy bruising and reduction in growth velocity or bone mineral densitometry 3, 5.
• Respiratory syncytial virus (RSV) infection can lead to reactive airway disease (RAD) in infants and adults, and may be a marker of a predisposing factor for asthma 6.
• Real-world data have shown that treatment with ICS/LABA therapies, such as fluticasone furoate/vilanterol, can reduce the risk of severe asthma exacerbations and improve lung function and symptom control in patients with asthma 7.

Key Findings

• ICS/LABA combinations are effective in improving asthma control and reducing exacerbations 3, 4, 7.
• ICS therapy can have local and systemic side effects 3, 5.
• RSV infection can lead to RAD and may be a marker of a predisposing factor for asthma 6.
• Real-world data support the use of ICS/LABA therapies in improving asthma outcomes 7.