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Overuse of albuterol is associated with excess risk for severe asthma exacerbations. Global Initiative for Asthma (GINA) guidelines recommend avoiding albuterol for all patients and using inhaled corticosteroids (ICS)/formoterol as a rescue inhaler. Although the National Asthma Education and Prevention Program (NAEPP) guidelines have not gone that far, they do recommend using as-needed ICS/albuterol for mild asthma.
In a multinational trial, more than 3100 adolescents and adults with uncontrolled moderate-to-severe asthma were randomized to either high- or low-dose albuterol/budesonide (180/160 µg or 180/80 µg) or albuterol alone (180 µg) as a rescue inhaler while continuing their current ICS or ICS/LABA (long-acting β-agonist) therapy. Afte…