They say “nothing stays the same” and as I keep aging, I couldn’t agree more! Change is always occurring in medical guidelines as well.  What I’d like to address here is how this applies to asthma therapy. 

For quite some time now, the standard of care for asthmatics has been to have both a rescue inhaler and a maintenance inhaler.  The majority of rescue inhalers use albuterol, a bronchodilator, which relaxes airway smooth muscles that are constricted.  The benefit is brief, lasting 3 to 6 hours, and the medication does not address the underlying inflammation which is the cause of the muscle constriction, that’s where a maintenance inhaler comes in.  Most maintenance inhalers are either single entity topical steroid or a combination steroid and long-acting bronchodilator. 

Overuse of albuterol is associated with excess risk for severe asthma exacerbations and even death.  Globally the majority of asthma related deaths are due to this scenario.  And a contributing cause is the cost of different inhalers: albuterol being relatively inexpensive while maintenance inhalers being expensive. 

This has led the Global Initiative for Asthma (GINA) to a new guideline that adds a topical steroid to all albuterol inhalers.  So far, the United States has not adopted this strategy.  Multiple international studies have documented a major improvement in patient outcomes with this approach:  marked reduction in the need for systemic steroids (oral or injected), reduced visits to emergency departments, reduced hospitalizations and reduced death.