Episode 954: Combo Rescue Inhalers - New Guidelines
04/30/25 • 3 min
1 Listener
Contributor: Aaron Lessen, MD
Educational Pearls:
What is a Rescue Inhaler?
- A rescue inhaler is a medication for people with asthma to quickly reverse the symptoms of an asthma attack.
- Historically albuterol (Short Acting Beta Agonist (SABA)) monotherapy has been the mainstay rescue inhaler. This is because albuterol works fast and is relatively cheap. \n\n
What are Combination Rescue Inhalers?
- Combination rescue inhalers contain a fast-acting bronchodilator as well as an inhaled corticosteroid (ICS)
- The steroid helps to reduce some of the chronic airway inflammation that is worsening the asthma attack and can help to prevent future attacks
- Examples include budesonide-formoterol and albuterol-budesonide
- Global Initiative for Asthma (GINA), states that combination therapy is now the preferred reliever for adults and adolescents with mild asthma
What are the drawbacks of Combination Rescue Inhalers?
- These inhalers are generally more expensive than just using a SABA inhaler which can be a barrier for some people \n\n
- Improper use can also lead to conditions like thrush due to the addition of the steroid
References
- Krings JG, Beasley R. The Role of ICS-Containing Rescue Therapy Versus SABA Alone in Asthma Management Today. J Allergy Clin Immunol Pract. 2024 Apr;12(4):870-879. doi: 10.1016/j.jaip.2024.01.011. Epub 2024 Jan 17. PMID: 38237858; PMCID: PMC10999356.
- Papi A, Chipps BE, Beasley R, Panettieri RA Jr, Israel E, Cooper M, Dunsire L, Jeynes-Ellis A, Johnsson E, Rees R, Cappelletti C, Albers FC. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med. 2022 Jun 2;386(22):2071-2083. doi: 10.1056/NEJMoa2203163. Epub 2022 May 15. PMID: 35569035.
Summarized by Jeffrey Olson, MS3 | Edited by Jorge Chalit, OMS3 \n\n
Contributor: Aaron Lessen, MD
Educational Pearls:
What is a Rescue Inhaler?
- A rescue inhaler is a medication for people with asthma to quickly reverse the symptoms of an asthma attack.
- Historically albuterol (Short Acting Beta Agonist (SABA)) monotherapy has been the mainstay rescue inhaler. This is because albuterol works fast and is relatively cheap. \n\n
What are Combination Rescue Inhalers?
- Combination rescue inhalers contain a fast-acting bronchodilator as well as an inhaled corticosteroid (ICS)
- The steroid helps to reduce some of the chronic airway inflammation that is worsening the asthma attack and can help to prevent future attacks
- Examples include budesonide-formoterol and albuterol-budesonide
- Global Initiative for Asthma (GINA), states that combination therapy is now the preferred reliever for adults and adolescents with mild asthma
What are the drawbacks of Combination Rescue Inhalers?
- These inhalers are generally more expensive than just using a SABA inhaler which can be a barrier for some people \n\n
- Improper use can also lead to conditions like thrush due to the addition of the steroid
References
- Krings JG, Beasley R. The Role of ICS-Containing Rescue Therapy Versus SABA Alone in Asthma Management Today. J Allergy Clin Immunol Pract. 2024 Apr;12(4):870-879. doi: 10.1016/j.jaip.2024.01.011. Epub 2024 Jan 17. PMID: 38237858; PMCID: PMC10999356.
- Papi A, Chipps BE, Beasley R, Panettieri RA Jr, Israel E, Cooper M, Dunsire L, Jeynes-Ellis A, Johnsson E, Rees R, Cappelletti C, Albers FC. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med. 2022 Jun 2;386(22):2071-2083. doi: 10.1056/NEJMoa2203163. Epub 2022 May 15. PMID: 35569035.
Summarized by Jeffrey Olson, MS3 | Edited by Jorge Chalit, OMS3 \n\n
Previous Episode
Episode 953: Penicillin Allergies
1 RecommendationsContributor: Geoff Hogan MD
Educational Pearls:
- Penicillin allergies are relatively uncommon despite their frequent reports
- 10% of the population reports a penicillin allergy but only 5% of these cases are clinically significant
- 90-95% of patients may tolerate a rechallenge after appropriate allergy evaluation
- Penicillin Allergy Decision Rule (PEN-FAST) on MD Calc
- Useful tool to assess patients for penicillin allergies
- Five years or less since reaction = 2 points (even if unknown)
- Anaphylaxis or angioedema OR Severe cutaneous reaction = 2 points
- Treatment required for reaction (e.g. epinephrine) = 1 point (even if unknown)
- A score of 0 on PEN-FAST indicates a less than 1% risk of a positive penicillin allergy test
- A score of 1 or 2 indicates a 5% risk of a positive penicillin allergy test
- A low score on PEN-FAST should prompt clinicians to proceed with the best empiric antibiotic for the patient’s infection
References
- Broyles AD, Banerji A, Barmettler S, et al. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs [published correction appears in J Allergy Clin Immunol Pract. 2021 Jan;9(1):603. doi: 10.1016/j.jaip.2020.10.025.] [published correction appears in J Allergy Clin Immunol Pract. 2021 Jan;9(1):605. doi: 10.1016/j.jaip.2020.11.036.]. J Allergy Clin Immunol Pract. 2020;8(9S):S16-S116. doi:10.1016/j.jaip.2020.08.006
- Piotin A, Godet J, Trubiano JA, et al. Predictive factors of amoxicillin immediate hypersensitivity and validation of PEN-FAST clinical decision rule [published correction appears in Ann Allergy Asthma Immunol. 2022 Jun;128(6):740. doi: 10.1016/j.anai.2022.04.005.]. Ann Allergy Asthma Immunol. 2022;128(1):27-32. doi:10.1016/j.anai.2021.07.005
- Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019;321(2):188-199. doi:10.1001/jama.2018.19283
- Trubiano JA, Vogrin S, Chua KYL, et al. Development and Validation of a Penicillin Allergy Clinical Decision Rule. JAMA Intern Med. 2020;180(5):745-752. doi:10.1001/jamainternmed.2020.0403
Summarized & edited by Jorge Chalit, OMS3
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