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Inhaled short-acting β2-adrenergic agonists, such as terbutaline and salbutamol, are the first-line drugs indicated for asthma exacerbation for all patients to provide rapid bronchodilating effects. [ 1 ] [ 2 ] Short-acting β2-adrenergic agonists can be delivered by different devices, for example, nebulizers and metered-dose inhalers .
While the use of inhaled steroids and long-acting beta2‑adrenergic agonists are recommended for the resulting improvement in control of symptoms of asthma, [10] concerns have been raised that salmeterol may increase the risk of death due to asthma, and this additional risk is not reduced by the addition of inhaled steroids. [11]
Budesonide, sold under the brand name Pulmicort, among others, is a steroid medication. [8] It is available as an inhaler, nebulization solution, pill, nasal spray, and rectal forms. [8] [9] The inhaled form is used in the long-term management of asthma and chronic obstructive pulmonary disease (COPD).
Fluticasone propionate, sold under the brand names Flovent and Flonase among others, is a glucocorticoid steroid medication. [8] When inhaled it is used for the long term management of asthma and COPD. [8] In the nose it is used for hay fever and nasal polyps. [9] [10] It can also be used for mouth ulcers. [11] It works by decreasing inflammation.
There were no asthma-related deaths and few asthma-related serious adverse events when salmeterol is used with an inhaled steroid. [5] [6] At least with formoterol, an increased risk appears to be present even when steroids are used [7] and this risk has not been ruled out for salmeterol. [8]
Fluticasone furoate/vilanterol, sold under the brand name Breo Ellipta among others, is a combination medication for the treatment of chronic obstructive pulmonary disease (COPD) and asthma. [3] It contains fluticasone furoate, an inhaled corticosteroid, and vilanterol, an ultra-long-acting β 2 agonist (ultra-LABA). [3]
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