March 28, 2023

Asthma medication change. Stopping Albuterol?

Okay so asthma is a really really horrible disease i am uh really frustrated by the way that impacts people’s lives but one of the things that i am noticing as i just come across more people in practice is that there are still a lot of people out there who are unaware of some of the changes in the asthma treatment guidelines one of the things that the gina initiative

Which is essentially you know the the world council of all things asthma one of the things that they’ve come up with recently is a change from your normal rescue inhaler if you are someone who’s had asthma in your family or in your own personal life you are familiar with albuterol albuterol has been the gold standard for probably longer than i’ve been alive but just

In the last couple years we’ve actually had a change to where they are now recommending that asthma should not be treated with a rescue inhaler of albuterol but that if you’re needing a rescue inhaler it should actually be a combination inhaler with a lava and an ics now a lava for those who are unfamiliar with the abbreviation is a long acting um beta agonist

Okay so a saba which is where albuterol falls in is a short acting beta agonist and this combination medicine the theory being that if you are having such a hard time breathing that you need to have a rescue inhaler it would be a good idea for you to have a longer effect of that and be a good idea to add some steroids to try and have two mechanisms of action trying

To treat the issues that you’re having and when they did studies they found that this was a way to reduce exacerbations in people by changing from albuterol as a rescue to this combination inhaler now the ones that they tended to use the uh budesonide and a femoral the um brand name for that would have been symbicort at the time there is now a generic out and

If you are just buying cash value from your pharmacy good rx puts branded symbicort somewhere around 350 inhaler which is very expensive i’m not gonna lie about that um and a generic budestimide from a roll comes in somewhere in the 250 range so it’s a little bit cheaper but there are now a guidelines of steps for what you would use and for essentially step one

You would and one and two you would basically use this uh rescue and halo to simba court this budestinide for motorol uh whenever you needed it much like you would use an albuterol hair so instead of carrying your albuterol inhaler around with you and if you have asthma or one of your friends has asthma your kids have asthma they should always have access to the

Rescue inhaler but instead of having albuterol they might carry this combination of the budesonide and fermoterol which is symbicort by brand name so that would be step one step two would be that they would go ahead and use that same medicine that low-dose ics lava that low-dose symbicort as both their controller and as their rescue so they would take they would

Take that daily plus whenever they felt they were having an exacerbation much like they were the albuterol and if that got worse you could increase the dose and go to a medium dose of the combination medicine of that symbiocord and if that medium dose ics combination with the lava wasn’t enough if that medium dose wasn’t enough to control then you would start

Adding on a third medicine called a llama muscarinic the generic of that would be a teotropium also known as spiriva in a lot of cases in terms of branding here in the u.s and that would be the progression you go now if you get that far you probably should be talking to a pulmonologist about some very specific testing i also noticed that there are a lot of people

Who believe they have a diagnosis of asthma because they had trouble breathing once someone handed them an albuterol inhaler in their life and it’s just really never left and they’ve never done actual pulmonary function testing they’ve never done any of the objective testing beyond saying yeah i have some shortness of breath and i take albuterol and they’re just

Diagnosed as having asthma and if that’s been where you’re living and that’s been your medical history it’s probably a good idea to check in with your physician and try and get some objective testing make sure we’re treating the right thing and that’s the thing that you should probably be aware of so if you have asthma or someone that you love has asthma it was

Probably weird hearing a physician saying hey maybe you don’t need albuterol because you need something different the gina guidelines again that’s the global initiative for asthma they have suggested and so far this seems to be a reasonable treatment change a big one for those of us who’ve been doing this for a while um i’m new so this isn’t that new to me but

This is a big change for people who’ve been living with an albuterol inhaler in their purse or in their pocket for the last 15 years right so talk to your physician see if this is right for you because if you are carrying an albuterol inhaler for asthma it might be time for change stay safe out there yo

Transcribed from video
Asthma medication change. Stopping Albuterol? By Dr Scott Bland