The Use of Albuterol/Budesonide As Reliever Therapy to Reduce Asthma Exacerbations

Prevention of asthma exacerbations and reduction of systemic corticosteroid burden remain unmet needs in asthma. US asthma guidelines recommend concomitant short -acting b 2 -agonist (SABA) and inhaled corticosteroid (ICS) as an alternative reliever at step 2. The Food and Drug Administration approved a pressurized metered -dose inhaler containing albuterol and budesonide for as -needed treatment or prevention of bronchoconstriction and for reducing exacerbation risk in patients with asthma aged double dagger 18 years. This combination is approved for use as a reliever with or without maintenance therapy, but it is not indicated for maintenance therapy (or for single maintenance and reliever therapy). Intervening with asneeded SABA-ICS during the window of opportunity to reduce in fl ammation during loss of asthma control can reduce exacerbation risk, by exerting both genomic and nongenomic anti-in fl ammatory effects. We propose that the use of albuterolbudesonide rather than albuterol as a reliever to manage episodic symptoms driven by acute bronchoconstriction and airway in fl ammation can improve outcomes. This combination approach, shown to decrease asthma exacerbations and oral corticosteroid burden in patients with moderate -to -severe asthma, represents a paradigm shift for asthma treatment in the United States. Further safety and efficacy studies should provide evidence that this type of reliever should be standard of care. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). (J Allergy Clin Immunol Pract 2024;12:882-8)