Combination of Albuterol/Budesonide a Game-Changer in Mild Asthma: Reynold Panettieri, Jr, MD

The recent approval of albuterol/budesonide could change the way that mild asthma is treated in patients, explained Reynold Panettieri, Jr, MD, vice chancellor for Translational Medicine and Science Director, Rutgers Institute for Translational Medicine and Science.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

How will the combination of albuterol/budesonide change the treatment of mild asthma?

This is a real game changer. Why? The drug Airsupra, that is the combination of budesonide/albuterol, was approved. But those approval studies, both in parallel, were done in moderate asthma. This [approval] reached down into the mild asthma, a group of patients who really lean heavily on the rescue therapy and albuterol.

Now, many of those patients didn't have an exacerbation for the first year they got in the study, but patients exacerbate. What we found in that study in mild asthmatics, even though they had no exacerbations 12 months before they developed an exacerbation in the subsequent 52 weeks, [was that] those patients on budesonide/albuterol had 26% less exacerbations.

Now remember, this is not a maintenance therapy. This is a rescue therapy. The rescue therapy contributed to decreasing exacerbation, but more important than that is that it decreased oral corticosteroid use associated with the exacerbation; that's a big deal. Prednisone causes cataracts, depression, diabetes, coronary artery disease, and so forth. We don't want patients to rely on prednisone, and this study shows a rescue inhaler can spare exacerbations and decrease systemic oral corticosteroid burden.

What does the growing body of data tell us about the role of anti-inflammatory reliever therapy across asthma severities?

If we look at all the studies, and there's been now a number of studies, as you mentioned, like DENALI and MANDELA. Those were registration studies. They were studies focused on very specific outcomes that would allow the registration of the drug. This is after the drug has been approved in the US to reach down [to] the mild patients. We're not talking about moderate patients anymore.

I think this is a game changer. We frequently use albuterol as a sole rescue. The problem with albuterol is it only reverses bronchoconstriction, not the inflammation, which is just as important in causing airflow obstruction. By giving the combination drug at a time, on demand, when the patient needs it, what we do is spare the ongoing inflammation, open the airways by relieving the smooth muscle, and improve outcomes.