What is the standard breathing treatment for asthma as needed in a patient?

From the Guidelines

The standard breathing treatment for asthma as needed in patients is a short-acting beta-agonist (SABA) bronchodilator, typically albuterol, administered via a metered-dose inhaler (MDI) with a spacer or through a nebulizer, with a dose of 4-12 puffs (or 2.5 mg via nebulizer) as needed, as recommended by the National Asthma Education and Prevention Program expert panel report 3 guidelines for the management of asthma exacerbations 1.

Key Points

• The treatment should be administered by trained personnel through a metered-dose inhaler (MDI) with a valved holding chamber or by means of nebulizer therapy 1.
• Nebulizer therapy might be preferred for those patients who are unable to cooperate effectively in using an MDI because of their age, agitation, or more severe exacerbations 1.
• In patients with severe exacerbations, continuous administration of b2-agonists might be more effective than intermittent administration 1.
• Only selective short-acting b-agonists (albuterol, levalbuterol, and pirbuterol) should be administered in high doses due to potential cardiotoxicity 1.

Administration and Monitoring

• Patients should be instructed to use their rescue inhaler when experiencing symptoms, before exercise if they have exercise-induced asthma, or as directed by their healthcare provider 1.
• If a patient needs to use their rescue medication more than twice weekly, this indicates poor asthma control, and they should consult their healthcare provider about adjusting their controller medication regimen 1.
• Proper inhaler technique is crucial for effective medication delivery, so patients should be taught to exhale fully before inhaling, create a proper seal around the mouthpiece, inhale slowly and deeply, and hold their breath for 10 seconds after inhalation 1.

From the FDA Drug Label

As with other inhaled beta-adrenergic agonists, albuterol sulfate inhalation solution can produce paradoxical bronchospasm, which can be life threatening. Patient Package Insert PATIENT’S INSTRUCTIONS FOR USE Read complete instructions carefully before using.

The standard breathing treatment for asthma as needed in a patient is to use albuterol or ipratropium bromide via a nebulizer as directed by a physician.

• Albuterol should be used with caution due to the risk of paradoxical bronchospasm.
• Ipratropium bromide can be mixed with albuterol in a nebulizer if used within one hour. The patient should follow the instructions for use and breathe calmly, deeply, and evenly until no more mist is formed in the nebulizer chamber (about 5 to 15 minutes) 2 3.

From the Research

Standard Breathing Treatment for Asthma as Needed in Patients

• The standard treatment for asthma as needed in patients involves the use of short-acting beta-agonists, such as salbutamol, which provide rapid relief of symptoms 4.
• However, regular use of short-acting beta-agonists as maintenance therapy for chronic asthma is no longer recommended, as it can increase airway hyper-responsiveness and decrease control of asthma 4.
• Long-acting beta-agonists, such as salmeterol and formoterol, can provide more prolonged bronchodilation and are indicated for patients whose asthma is not well controlled on moderate doses of inhaled corticosteroids 4.
• Combination therapy with inhaled corticosteroids and long-acting beta-agonists is effective in patients for whom inhaled corticosteroids alone are insufficient 5.
• Anticholinergic agents, such as ipratropium bromide, can be used in combination with beta-agonists to produce better bronchodilation, particularly in patients with more severe episodes of asthma 6, 7.

Recommendations for Asthma Treatment

• The Chinese Thoracic Society recommends that patients with limited to occasional transient daytime symptoms (<2 times/month, lasting hours), no nocturnal symptoms, no risk of exacerbations, and FEV1>80% predicted be treated with as-needed low-dose ICS-formoterol 8.
• Patients with persistent symptoms or exacerbations despite correct inhalation technique and adherence to treatment should be referred to asthma specialists or specialized clinics for further evaluation 8.
• Follow-up visits should be scheduled every 2-4 weeks after initial therapy, then every 1-3 months if there is a response, and regular training of patients in the correct use of inhaler techniques is essential for optimal asthma control 8.

Severe Asthma Treatment

• Severe asthma is uncontrolled asthma despite prescribing 3 or more months of continuous standardized use of a medium- or high-dose ICS-LABA and has been treated for comorbidity diseases and avoid environmental stimulus, or worsening after stepping down to a lower dose ICS-LABA 8.
• Patients with severe type 2 asthma can be treated with biologic therapy, and those who had a good response to type 2-targeted biologic therapies can prioritize decrease or stop maintenance OCS therapy, but should not completely stop maintenance therapy with ICS-LABA 8.