From the Guidelines
Nonsteroidal inhalers for asthma are crucial for managing the condition, and the most effective options include long-acting beta-agonists (LABAs), short-acting beta-agonists (SABAs), anticholinergics, and mast cell stabilizers, as evidenced by the guidelines from the Mayo Clinic Proceedings 1 and American Family Physician 1.
Types of Nonsteroidal Inhalers
- Long-acting beta-agonists (LABAs) like salmeterol and formoterol, which relax airway muscles for up to 12 hours, as recommended by the American Family Physician 1
- Short-acting beta-agonists (SABAs) like albuterol and levalbuterol, which provide quick relief during asthma attacks, as outlined in the Mayo Clinic Proceedings 1
- Anticholinergics such as ipratropium and tiotropium, which block nerve signals that tighten airways, as discussed in the American Family Physician 1
- Mast cell stabilizers like cromolyn sodium, which prevent inflammatory chemicals from being released, as mentioned in the Mayo Clinic Proceedings 1
Mechanism of Action
These medications work through different mechanisms than steroids, with beta-agonists directly relaxing airway muscles by stimulating beta-receptors, anticholinergics blocking acetylcholine to prevent airway constriction, and mast cell stabilizers preventing inflammatory mediator release, as explained in the American Family Physician 1.
Clinical Use
Nonsteroidal options are particularly valuable for patients concerned about steroid side effects, though they're often used alongside inhaled corticosteroids rather than as complete replacements for comprehensive asthma management, as recommended by the Mayo Clinic Proceedings 1 and American Family Physician 1.
Key Considerations
The guidelines emphasize the importance of using LABAs in combination with inhaled corticosteroids, rather than as monotherapy, due to potential safety concerns, as highlighted in the Mayo Clinic Proceedings 1 and American Family Physician 1.
From the Research
Nonsteroidal Inhalers for Asthma
- Nonsteroidal inhalers for asthma include short-acting beta-2-agonists (SABAs) and anticholinergics, which are used to relieve bronchospasm and other symptoms associated with asthma 2, 3, 4, 5.
- SABAs, such as salbutamol, are commonly used as rescue medications to quickly relieve asthma symptoms, but their overuse can be associated with an increased risk of severe exacerbations and asthma-related hospitalizations 2, 4.
- Anticholinergics, such as ipratropium bromide, may be used in addition to SABAs to help relieve bronchospasm, but their effectiveness in children hospitalized for acute asthma is unclear 3.
- Inhaled corticosteroids (ICSs) are often underused in asthma treatment, despite their effectiveness in reducing inflammation and preventing exacerbations 2, 4.
- Patient characteristics, such as age, smoking status, and socioeconomic factors, can influence the use of SABAs and ICSs, with certain populations being more susceptible to SABA overreliance and ICS underuse 4.
Types of Nonsteroidal Inhalers
- Short-acting beta-2-agonists (SABAs):
- Salbutamol
- Fenoterol
- Anticholinergics:
- Ipratropium bromide
Usage Patterns and Outcomes
- SABA overreliance is prevalent, with approximately 20% of adults using 3 or more canisters per year 4.
- ICS underuse is also common, with varying thresholds used to define suboptimal use 4.
- SABA overreliance is associated with increased risk of severe exacerbations, asthma-related hospitalizations, and emergency department visits 2, 4.