ozdreaming, {Acronym alert - glossary at bottom.} I see more #asthma patients getting bumped from ICS-only monotherapy (and/or SABA-only rescue med) to combo ICS-LABA inhalers. This is spurred by GSK discontinuing brand-name Flovent, and GINA guidelines promoting AIR and MART (aka SMART) strategy, which utilizes a combo inhaler containing formoterol, like Symbicort, Breyna, or Dulera. This is a big change for many people, who're used to using an inhaled #steroid for control and prevention, and inhaled #albuterol for rapid relief. Now they can use one inhaler for both -- which is convenient, and may bring better control.
Explainer "What is SMART Therapy for Asthma?": https://allergyasthmanetwork.org/news/asthma-smart-therapy/
Now I'm also seeing PCPs, pediatricians, and pulmonologists prescribing other combo ICS-LABA inhalers like Advair with a SMART asthma action plan -- even though that's not approved under GINA or NAEPP guidelines. In fact they explicitly warn against this: "Combination ICS with non-formoterol LABA cannot be used as-needed for symptom relief." (GINA main report, p. 69). LABAs like salmeterol (more lipophilic) take much longer to kick in (30+ minutes) to be intended for rapid relief, and have not been studied for rescue use. But they're being prescribed that way anyway, presumably due to availability, insurance coverage, and clinician confusion during a time of flux. Leading to a lot of follow-up conversations. :blobcatshrug:
GINA 2023 main report: https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Full-report-23_07_06-WMS.pdf .
NIH NAEPP 2020 Asthma Guidelines: https://www.jacionline.org/article/S0091-6749(20)31404-4/fulltext
Glossary (in no order):
- ICS == inhaled corticosteroid (Flovent, QVAR). Steroids reduce airway inflammation slowly over time.
- SABA == short-acting beta-agonist: a bronchodilator (canonically albuterol) that quickly relieves airway constriction, for a few hours.
- LABA == long-acting beta-agonist (ex: salmeterol, formoterol), relieves airway symptoms for more than a few hours.
- Rescue med, aka "reliever" == a rapid-acting drug to relieve acute symptoms (e.g. albuterol, epinephrine).
- Maintenance therapy == drug you take daily to prevent acute symptoms.
- Monotherapy == managing a disease with just one drug.
- AIR == Anti-Inflammatory Reliever: combo inhaler with a low-dose steroid + a rapid-acting bronchodilator
- MART == Maintenance And Reliever Therapy: treatment with an inhaler that contains both a steroid and a rapid-onset, long-acting beta-agonist (formoterol). Also called SMART (S == "Single-inhaler").
- GINA == Global Initiative on Asthma
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