What is a good rescue inhaler (inhalation device)?

From the Guidelines

A good rescue inhaler is a short-acting beta-agonist (SABA) such as albuterol (also known as salbutamol) delivered via a dry powder inhaler (DPI) or a metered-dose inhaler (MDI) with a spacer, as these devices have been shown to be effective in delivering medication and reducing greenhouse gas emissions 1.

Key Considerations

• The choice of rescue inhaler should be based on patient preference, ability to use the device, and clinical effectiveness, with DPIs being a viable option for many patients 1.
• Proper technique is crucial when using a rescue inhaler, and patients should be instructed on how to use the device correctly, including the use of a spacer with MDIs 1.
• Patients who require their rescue inhaler more than twice weekly should seek medical attention, as this indicates poor asthma control and may require adjustment of controller medications.

Device Options

• DPIs have been shown to be as effective as MDIs with spacers in delivering SABAs, and may be preferred by some patients due to their ease of use and lower environmental impact 1.
• MDIs with spacers can also be effective, but may require more coordination and technique from the patient, and have a higher environmental impact than DPIs 1.

Environmental Impact

• The use of DPIs and lower-carbon footprint MDIs can help reduce the environmental impact of asthma prescribing, and should be considered when selecting a rescue inhaler 1.
• CCGs may want to consider excluding higher footprint MDIs, such as Ventolin Evohaler, Flutiform, and Symbicort MDI, except in circumstances where no acceptable similarly effective lower footprint device could be found 1.

From the FDA Drug Label

The bronchodilator responses to 1.25 mg of Xopenex Inhalation Solution and 2. 5 mg of racemic albuterol sulfate inhalation solution were clinically comparable over the 6-hour evaluation period, except for a slightly longer duration of action (>15% increase in FEV1 from baseline) after administration of 1. 25 mg of Xopenex Inhalation Solution. Racemic albuterol delivered by a chlorofluorocarbon (CFC) metered dose inhaler (MDI) was used on an as-needed basis as the rescue medication Efficacy, as measured by the mean percent change from baseline FEV1, was demonstrated for all active treatment regimens compared with placebo on day 1 and day 29.

Levalbuterol (Xopenex) is a good rescue inhaler, with 1.25 mg being a commonly used dose. It has been shown to be clinically comparable to racemic albuterol sulfate inhalation solution in terms of bronchodilator response. The duration of action of levalbuterol is slightly longer than that of racemic albuterol sulfate inhalation solution. 2

From the Research

Rescue Inhalers for Asthma and COPD

• A good rescue inhaler for asthma and COPD should provide quick relief from symptoms and prevent exacerbations.
• According to a study published in 1998 3, short-acting beta-agonists such as salbutamol are effective for relieving symptoms, but their regular use as maintenance therapy is not recommended.
• Another study from 2003 4 found that using short-acting beta-2 agonists only as needed, rather than regularly, is the recommended approach for managing asthma symptoms.
• A study published in 2013 5 compared the effectiveness of salbutamol alone versus salbutamol combined with ipratropium bromide in treating acute severe asthma, and found that the combination therapy provided greater bronchodilation.

Combination Therapies

• Combination therapies, such as salbutamol and ipratropium bromide, may be more effective than single-agent therapies for managing asthma and COPD symptoms 5, 6.
• A study from 2010 6 reviewed the mechanism of action, clinical efficacy, and safety of albuterol, ipratropium, and combined albuterol-ipratropium therapy for COPD treatment.
• Another study from 2007 7 compared the bronchodilator responses of levosalbutamol and salbutamol given via a pressurized metered dose inhaler, and found that both drugs produced similar bronchodilator responses.

Key Findings

• Short-acting beta-agonists such as salbutamol are effective for relieving asthma symptoms, but their regular use as maintenance therapy is not recommended 3.
• Combination therapies, such as salbutamol and ipratropium bromide, may be more effective than single-agent therapies for managing asthma and COPD symptoms 5, 6.
• Levosalbutamol, the (R)-enantiomer of salbutamol, has been shown to produce similar bronchodilator responses to salbutamol when administered via a pressurized metered dose inhaler 7.