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August 16, 2022
Albuterol–Budesonide Combination for Asthma Exacerbation: Asthma exacerbations are increasing in prevalence and result in serious complications such as hospitalizations and death. For acute treatment of flare-ups, the benefit of short-acting β2-agonists may be limited because they do not address the underlying airway inflammation compared to inhaled corticosteroids. A Phase 3, multinational, randomized, double-blinded trial demonstrated an albuterol-budesonide combination at higher and lower doses was effective compared to albuterol monotherapy for patients aged 4 years and older with uncontrolled moderate to severe asthma. The frequency of adverse events was similar among the three treatment groups. With these positive results, the first-in-class combination was recently submitted to the U.S. Food and Drug Administration for approval and may provide better access and outcomes for patients.
Upon completion of the chapter, the reader will be able to:
Describe the pathophysiology and clinical presentation of acute and chronic asthma.
List the treatment goals for asthma.
Identify environmental factors associated with worsening asthma control.
Discuss the factors to consider when choosing an inhaled drug delivery device for a patient.
Recommend an asthma medication regimen for an adult patient based on symptoms.
Compare the preferred asthma reliever and controller regimens for children, adolescents, and adults.
Describe the purpose of an individualized asthma action plan.
Asthma is a disorder of the airways characterized by chronic airway inflammation, bronchial hyperresponsiveness, and airflow obstruction. Patients with asthma typically present with respiratory symptoms such as wheezing, shortness of breath, chest tightness, and cough. These symptoms vary over time and in intensity, and worsening is often triggered by factors such as exercise, allergen exposure, change in weather, or respiratory infections.1 Severity of chronic asthma ranges from mild intermittent symptoms to severe and disabling disease. Despite variability in the severity of chronic asthma, all patients with asthma are at risk of acute severe exacerbations that may be life threatening. International guidelines emphasize the importance of treating underlying airway inflammation to control asthma and reduce asthma-associated risks.1–5
EPIDEMIOLOGY AND ETIOLOGY
Asthma is the most prevalent chronic disease of childhood, and it causes significant morbidity and mortality in both adults and children. About 262 million adults and children worldwide have asthma.6 In the United States, asthma affects 8% of adults (20 million) and 7% of children (5.1 million).7 Asthma is the primary diagnosis for 9.8 million physician office visits, 1.6 million emergency department visits, and 3524 deaths annually.7 In 2019, 41.2% of persons with asthma reported having one or more asthma attacks, indicating that nearly half of patients with asthma are not optimally controlled.8
Asthma is also a significant economic burden. Annual per-person medical costs have been estimated to ...