Don’t Jump to Airsupra for Asthma Rescue

Reps will tout albuterol/budesonide (Airsupra) as the first “dual-action” rescue inhaler FDA-approved for asthma in adults.

We’re used to reaching for albuterol for quick relief.

But this new short-acting beta-agonist/inhaled corticosteroid (ICS) combo aligns with guidelines moving toward anti-inflammatory reliever (AIR) options...instead of using albuterol alone.

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That’s because a fast-acting beta-agonist (albuterol, formoterol) WITH an ICS for rescue also reduces asthma exacerbations. And overuse of albuterol alone can increase exacerbation risk.

Keep in mind, both albuterol and formoterol work within 5 minutes...and albuterol lasts up to 6 hours, but formoterol up to 12 hours.

Don’t jump to prn albuterol/budesonide for quick relief.

There’s no proof it’s more effective than prn long-acting beta-agonist formoterol/ICS combos (Symbicort, Dulera). And these can be used for maintenance and reliever therapy (MART), previously called SMART.

Plus albuterol/budesonidecosts about $475/inhaler. Anticipate payer rejects.

Recommend a formoterol/ICS combo for most adults and patients can use one inhaler for rescue...and maintenance, if needed.

Formoterol/budesonide (Symbicort) costs about $200/inhaler...and formoterol/mometasone (Dulera) about $300.

Suggest starting a low-dose formoterol/ICS combo prn as a reliever for mild asthma. If symptoms worsen or if patients have more severe asthma, advise using formoterol/ICS bid as a maintenance med AND prn for rescue...instead of adding another inhaler.

Be aware, some payers may prefer using albuterol plus an ICS separately before authorizing albuterol/budesonide. For example, generic albuterol costs about $30/inhaler...and mometasone (Asmanex) around $100.

Point out this aligns with guidelines that recommend prn albuterol with an ICS...OR prn alternative rescue options to MART.

Continue to assess adherence and proper inhaler technique regularly.

Use our resource, Correct Use of Inhalers, to guide proper use...and for info on priming, cleaning, and beyond-use dates.

Ensure patients understand their asthma action plan.

See how inhalers stack up in our resource, Comparison of Asthma Medications. Dig into our resource, Improving Asthma Care, for how to treat asthma in kids, preventive measures, and patient education.

Key References

  • Papi A, Chipps BE, Beasley R, et al. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med. 2022 Jun 2;386(22):2071-2083.
  • Chipps BE, Israel E, Beasley R, et al. Albuterol-Budesonide Pressurized Metered Dose Inhaler in Patients With Mild-to-Moderate Asthma: Results of the DENALI Double-Blind Randomized Controlled Trial. Chest. 2023 Sep;164(3):585-595.
  • Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Updated 2023. (Accessed February 29, 2024).
  • Crossingham I, Turner S, Ramakrishnan S, et al. Combination fixed-dose beta agonist and steroid inhaler as required for adults or children with mild asthma. Cochrane Database Syst Rev. 2021 May 4;5(5):CD013518.
Pharmacist's Letter. April 2024, No. 400402

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