Current Trends in Asthma

The burden of asthma remains high1-3

Asthma Attacks USA MapAsthma Attacks USA Map

*Data from 2016-2018.

Real-World Evidence

Regardless of SABA use or adherence to maintenance therapy, roughly half of patients with asthma experienced at least one exacerbation in a given year.5†

IBM MarketScan DatabaseIBM MarketScan Database

†Analysis of US administrative claims data from IBM MarketScan databases to determine real-world associations between SABA use and severe exacerbations in patients ≥12 years old with asthma (9/30/2014 to 9/30/2016).5

Expert Opinions

NAEPP Guidelines and the GINA Report support treating symptoms and inflammation concomitantly with rescue/reliever therapy6,7

Key Recommendations in Patients ≥12 Years Old

NAEPP Focused Updates 20206

  • Preferred in treatment steps 2-4:

    • Step 2: Daily low-dose ICS and as-needed SABA or as-needed concomitant ICS and SABA

    • Steps 3 and 4: Daily and as-needed combination ICS-formoterol‡§

GINA 20247

  • In Track 1 (preferred): As-needed low-dose ICS-formoterol‡ is the recommended reliever§

  • In Track 2 (alternative): Reliever options include:

    • as-needed ICS-SABA, or

    • as-needed SABA (if given with concomitant as-needed ICS or daily maintenance ICS)

  • The GINA report no longer recommends SABA-only treatment of asthma

‡The use of ICS-formoterol is not approved for maintenance and rescue therapy or for as-needed rescue only in the United States. The recommendations for ICS-formoterol are based on clinical data evaluating the use of ICS-formoterol formulations and strengths not approved and not available in the United States.

§ICS-formoterol should not be used as a reliever by patients who are taking a different maintenance ICS-LABA.6,7 The use of ICS-formoterol with other LABAs may be associated with increased adverse effects.

Note: not a complete list of recommendations; full recommendations are at references provided below.

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Evaluate patients’ levels of asthma control

Find out more about the Asthma Impairment and Risk Questionnaire (AIRQ®) and assessing your patients' level of asthma control.

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Expert Opinions

The latest recommendations from GINA and NAEPP have shifted, supporting a rescue approach that aims to treat symptoms and inflammation concomitantly6,7

GINA 20236‡

  • Reliever

    As-needed low-dose ICS-formoterol§║

  • Steps 1-2

    As-needed-only low-dose ICS-formoterol§║

  • Step 3

    Low-dose maintenance ICS-formoterol║

  • Step 4

    Medium-dose maintenance ICS-formoterol║

  • Step 5

    Add-on LAMA. Refer for phenotypic assessment ± biologic therapy. Consider high-dose ICS-formoterol║

  • Reliever

    As-needed SABA or as-needed ICS-SABA§

  • Step 1

    Take ICS whenever SABA is taken§

  • Step 2

    Low-dose maintenance ICS

  • Step 3

    Low-dose maintenance ICS-LABA

  • Step 4

    Medium-/high-dose maintenance ICS-LABA

  • Step 5

    Add-on LAMA. Refer for phenotypic assessment ± biologic therapy. Consider high-dose ICS-LABA

‡Recommendations for patients >/=12 years old.

§Anti-inflammatory relievers (AIR).

║The use of ICS-formoterol is not approved for maintenance and rescue therapy in the United States. The recommendations for ICS-formoterol are based on clinical data evaluating the use of ICS-formoterol formulations and strengths not approved and not available in the United States.

NAEPP Focused Updates 20207‡

Preferred
  • Step 1

    As-needed SABA

  • Step 2

    Daily low-dose ICS and as-needed SABA OR As-needed concomitant ICS and SABA

  • Step 3

    Daily and as-needed combination low-dose ICS-formoterol‖

  • Step 4

    Daily and as-needed combination medium-dose ICS-formoterol║

  • Step 5

    Daily medium-/high-dose ICS-LABA + LAMA and as-needed SABA

  • Step 6

    Daily high-dose ICS-LABA + OCS + as-needed SABA

Rethinking Asthma Rescue

Challenges in asthma care

Learn More

Exacerbation study
for a rescue therapy

Learn More

Lung function study
for a rescue therapy

Learn More

Additional resources and learning

Learn More

GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; MPR, medication possession ratio; NAEPP, National Asthma Education and Prevention Program; SABA, short-acting ß2-agonist.

References:

1. American Lung Association. Asthma trends and burden. Accessed June 24, 2024. https://www.lung.org/research/trends-in-lung-disease/asthma-trends-brief/trends-and-burden. 2. Centers for Disease Control and Prevention. Asthma Data Visualizations. Accessed June 24, 2024. https://www.cdc.gov/asthma/data-visualizations/default.htm. 3. Centers for Disease Control and Prevention. Most Recent National Asthma Data. Accessed June 24, 2024. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm. 4. Pate CA, Zahran HS, Qin X, et al. Asthma surveillance—United States, 2006-2018. MMWR Surveill Summ. 2021;70(5):1-32. https://doi.org/10.15585/mmwr.ss7005a1. 5. Lugogo N, Gilbert I, Tkacz J, et al. Real-world patterns and implications of short-acting β2-agonist use in patients with asthma in the United States. Ann Allergy Asthma Immunol. 2021;126(6):681-689.e1. doi:10.1016.j.anai.2021.01.024. 6. Cloutier MM, Baptist AP, Blake KV, et al; Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC). 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146(6):1217-1270. doi:10.1016/j.jaci.2020.10.003. 7. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2024. Updated May 2024. Accessed June 24, 2024. Available from: www.ginasthma.org.

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IMPORTANT SAFETY INFORMATION

  • Contraindications: Hypersensitivity to albuterol, budesonide, or to any of the excipients

  • Deterioration of Asthma: Asthma may deteriorate acutely over a period of hours or chronically over several days or longer. If the patient continues to experience symptoms after using AIRSUPRA or requires more doses of AIRSUPRA than usual, it may be a marker of destabilization of asthma and requires evaluation of the patient and their treatment regimen

  • Paradoxical Bronchospasm: AIRSUPRA can produce paradoxical bronchospasm, which may be life threatening. Discontinue AIRSUPRA immediately and institute alternative therapy if paradoxical bronchospasm occurs. It should be recognized that paradoxical bronchospasm, when associated with inhaled formulations, frequently occurs with the first use of a new canister

  • Cardiovascular Effects: AIRSUPRA, like other drugs containing beta2-adrenergic agonists, can produce clinically significant cardiovascular effects in some patients, as measured by pulse rate, blood pressure, and/or other symptoms. If such effects occur, AIRSUPRA may need to be discontinued. In addition, beta-agonists have been reported to produce electrocardiogram (ECG) changes, such as flattening of the T wave, prolongation of the QTc interval, and ST-segment depression. Therefore, AIRSUPRA, like all sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension

  • Do Not Exceed Recommended Dose: Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs

  • Hypersensitivity Reactions, Including Anaphylaxis: Can occur after administration of albuterol sulfate and budesonide, components of AIRSUPRA, as demonstrated by cases of anaphylaxis, angioedema, bronchospasm, oropharyngeal edema, rash, and urticaria. Discontinue AIRSUPRA if such reactions occur

  • Risk of Sympathomimetic Amines with Certain Coexisting Conditions: AIRSUPRA, like all therapies containing sympathomimetic amines, should be used with caution in patients with convulsive disorders, hyperthyroidism, or diabetes mellitus and in patients who are unusually responsive to sympathomimetic amines

  • Hypokalemia: Beta-adrenergic agonist medicines may produce significant hypokalemia in some patients. The decrease in serum potassium is usually transient, not requiring supplementation

  • Immunosuppression and Risk of Infections: Due to possible immunosuppression from the use of inhaled corticosteroids (ICS), potential worsening of infections could occur. Use with caution. A more serious or fatal course of chickenpox or measles can occur in susceptible patients

  • Oropharyngeal Candidiasis: Has occurred in patients treated with ICS agents. Monitor patients periodically. Advise patients to rinse his/her mouth with water, if available, without swallowing after inhalation

  • Hypercorticism and Adrenal Suppression: May occur with very high doses in susceptible individuals. If such changes occur, consider appropriate therapy

  • Reduction in Bone Mineral Density: Decreases in bone mineral density have been observed with long-term administration of ICS. For patients at high risk for decreased bone mineral density, assess initially and periodically thereafter

  • Glaucoma and Cataracts: Have been reported following the long-term administration of ICS, including budesonide, a component of AIRSUPRA

  • Effects on Growth: Orally inhaled corticosteroids, including budesonide, may cause a reduction in growth velocity when administered to pediatric patients. The safety and effectiveness of AIRSUPRA have not been established in pediatric patients, and AIRSUPRA is not indicated for use in this population

  • Most common adverse reactions (incidence ≥ 1%) are headache, oral candidiasis, cough, and dysphonia

  • Drug Interactions: AIRSUPRA should be administered with caution to patients being treated with:

  • Strong cytochrome P450 3A4 inhibitors (may cause systemic corticosteroid effects)

  • Short-acting bronchodilators (concomitant use of additional beta-agonists with AIRSUPRA should be used judiciously to prevent beta-agonist overdose)

  • Beta-blockers (may block pulmonary effects of beta-agonists and produce severe bronchospasm)

  • Diuretics or non-potassium-sparing diuretics (may potentiate hypokalemia or ECG changes). Consider monitoring potassium levels

  • Digoxin (may decrease serum digoxin levels). Consider monitoring digoxin levels

  • Monoamine oxidase inhibitors (MAOI) or tricyclic antidepressants (Use AIRSUPRA with extreme caution; may potentiate effect of albuterol on the cardiovascular system)

  • Use AIRSUPRA with caution in patients with hepatic impairment, as budesonide systemic exposure may increase. Monitor patients with hepatic disease

INDICATION

AIRSUPRA is a combination of albuterol, a beta2-adrenergic agonist and budesonide, a corticosteroid, indicated for the as-needed treatment or prevention of bronchoconstriction and to reduce the risk of exacerbations in patients with asthma 18 years of age and older.

Please see full Prescribing Information, including Patient Information.

You may report side effects related to AstraZeneca products.

IMPORTANT SAFETY INFORMATION

  • Contraindications: Hypersensitivity to albuterol, budesonide, or to any of the excipients

  • Deterioration of Asthma: Asthma may deteriorate acutely over a period of hours or chronically over several days or longer. If the patient continues to experience symptoms after using AIRSUPRA or requires more doses of AIRSUPRA than usual, it may be a marker of destabilization of asthma and requires evaluation of the patient and their treatment regimen

  • Paradoxical Bronchospasm: AIRSUPRA can produce paradoxical bronchospasm, which may be life threatening. Discontinue AIRSUPRA immediately and institute alternative therapy if paradoxical bronchospasm occurs. It should be recognized that paradoxical bronchospasm, when associated with inhaled formulations, frequently occurs with the first use of a new canister

  • Cardiovascular Effects: AIRSUPRA, like other drugs containing beta2-adrenergic agonists, can produce clinically significant cardiovascular effects in some patients, as measured by pulse rate, blood pressure, and/or other symptoms. If such effects occur, AIRSUPRA may need to be discontinued. In addition, beta-agonists have been reported to produce electrocardiogram (ECG) changes, such as flattening of the T wave, prolongation of the QTc interval, and ST-segment depression. Therefore, AIRSUPRA, like all sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension

  • Do Not Exceed Recommended Dose: Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs

  • Hypersensitivity Reactions, Including Anaphylaxis: Can occur after administration of albuterol sulfate and budesonide, components of AIRSUPRA, as demonstrated by cases of anaphylaxis, angioedema, bronchospasm, oropharyngeal edema, rash, and urticaria. Discontinue AIRSUPRA if such reactions occur

  • Risk of Sympathomimetic Amines with Certain Coexisting Conditions: AIRSUPRA, like all therapies containing sympathomimetic amines, should be used with caution in patients with convulsive disorders, hyperthyroidism, or diabetes mellitus and in patients who are unusually responsive to sympathomimetic amines

  • Hypokalemia: Beta-adrenergic agonist medicines may produce significant hypokalemia in some patients. The decrease in serum potassium is usually transient, not requiring supplementation

  • Immunosuppression and Risk of Infections: Due to possible immunosuppression from the use of inhaled corticosteroids (ICS), potential worsening of infections could occur. Use with caution. A more serious or fatal course of chickenpox or measles can occur in susceptible patients

  • Oropharyngeal Candidiasis: Has occurred in patients treated with ICS agents. Monitor patients periodically. Advise patients to rinse his/her mouth with water, if available, without swallowing after inhalation

  • Hypercorticism and Adrenal Suppression: May occur with very high doses in susceptible individuals. If such changes occur, consider appropriate therapy

  • Reduction in Bone Mineral Density: Decreases in bone mineral density have been observed with long-term administration of ICS. For patients at high risk for decreased bone mineral density, assess initially and periodically thereafter

  • Glaucoma and Cataracts: Have been reported following the long-term administration of ICS, including budesonide, a component of AIRSUPRA

  • Effects on Growth: Orally inhaled corticosteroids, including budesonide, may cause a reduction in growth velocity when administered to pediatric patients. The safety and effectiveness of AIRSUPRA have not been established in pediatric patients, and AIRSUPRA is not indicated for use in this population

  • Most common adverse reactions (incidence ≥ 1%) are headache, oral candidiasis, cough, and dysphonia

  • Drug Interactions: AIRSUPRA should be administered with caution to patients being treated with:

  • Strong cytochrome P450 3A4 inhibitors (may cause systemic corticosteroid effects)

  • Short-acting bronchodilators (concomitant use of additional beta-agonists with AIRSUPRA should be used judiciously to prevent beta-agonist overdose)

  • Beta-blockers (may block pulmonary effects of beta-agonists and produce severe bronchospasm)

  • Diuretics or non-potassium-sparing diuretics (may potentiate hypokalemia or ECG changes). Consider monitoring potassium levels

  • Digoxin (may decrease serum digoxin levels). Consider monitoring digoxin levels

  • Monoamine oxidase inhibitors (MAOI) or tricyclic antidepressants (Use AIRSUPRA with extreme caution; may potentiate effect of albuterol on the cardiovascular system)

  • Use AIRSUPRA with caution in patients with hepatic impairment, as budesonide systemic exposure may increase. Monitor patients with hepatic disease

INDICATION

AIRSUPRA is a combination of albuterol, a beta2-adrenergic agonist and budesonide, a corticosteroid, indicated for the as-needed treatment or prevention of bronchoconstriction and to reduce the risk of exacerbations in patients with asthma 18 years of age and older.

Please see full Prescribing Information, including Patient Information.

You may report side effects related to AstraZeneca products.