NEW TREATMENT OPTIONS FOR MILD ASTHMA – A DUAL PURPOSE RELIEVER
There has been an update to the way we approach treating mild asthma, with the inclusion of a dual purpose reliever (budesonide/formoterol). The combination of budesonide/formoterol, the two active ingredients in the single inhaler, when used as needed, relieves symptoms and reduces the risk of experiencing serious asthma flare-ups (attacks).
What is ‘mild’ asthma?
- You experience few symptoms
- Do not wake at night due to symptoms
- Have not experienced a flare-up in the past year.
If this definition is familiar to you, discuss your treatment options with your doctor, and seek advice specifically on whether you should be on a regular or an as-needed treatment regime.
About the new treatment options
There are now three options to manage symptoms in mild asthma for adults and adolescents in Australia.
- Regular low-dose preventer plus blue/grey reliever as needed
- Dual purpose reliever (budesonide/formoterol) to be used as needed
- Blue/grey reliever to be used as needed
It will be important to discuss these options with your doctor, ensuring that your treatment plan is tailored to your individual circumstances and your needs.
Finding suitable treatment for you
First and foremost, the diagnosis of asthma needs to be established by your doctor. From that point, your doctor will discuss with you the right treatment according to a comprehensive assessment of your condition, factors affecting your asthma, and your lifestyle and medication preferences.
We encourage you to have a discussion with your doctor about the type of asthma you have and how severe it is. Together you should decide on the right treatment option for you with the aim to achieve well-controlled asthma, reduce the risk of serious flare-ups and improve your quality of life.
If you are already using a regular preventer, have good asthma control, and are not experiencing asthma symptoms, this is a good place to be and a change to your plan should not occur before carefully discussing your options with your doctor.
If you are experiencing frequent and/or severe asthma symptoms, irrespective of your current plan, you should visit your doctor urgently and discuss your treatment options.
What is the ‘dual purpose reliever’ (budesonide/formoterol)?
The dual purpose reliever (budesonide/formoterol) medication contains two components:
- One which opens the airways (formoterol)
- One which aims to treat the inflammation that causes asthma symptoms (budesonide).
The combination of these two ingredients in the single inhaler, when used as needed, relieves symptoms and reduces your risk of experiencing serious asthma flare-ups (attacks).
It’s not a new medication but actually a new way of using a medication that’s been available in Australia for some time.
It is important to recognise and treat your asthma symptoms, even mild symptoms. If you are finding yourself using your dual purpose reliever often (more than three days per week), it’s important you see your doctor for an asthma review.
But what is ‘budesonide/formoterol’?
Budesonide and formoterol are what we call ‘generic names’, the names of the active ingredients in the dual purpose reliever which is packaged as DuoResp or Symbicort by the respective drug manufacturer. We feel it’s important to start to introduce these generic names because prescriptions in Australia will start to be produced using generic names only (listing the active ingredients) and we want you to be fully aware of what these are.
How is this medicine available?
The dual purpose reliever (budesonide/formoterol) medicine is available as prescription-only, meaning it is only available with a prescription from a doctor. Asthma Australia strongly recommends that all people with asthma visit their doctor for an asthma review, at least once per year (children at least twice). Even people with infrequent and mild symptoms.
If you are someone who has accessed your blue/grey reliever medicine over the counter without a diagnosis of asthma made by your doctor, you are not alone. 1 in 5 people who obtain their reliever over the counter does not have a doctor diagnosis of asthma. Asthma Australia strongly recommends you take this opportunity to visit a doctor to discuss your symptoms and obtain a diagnosis.
Even if you feel you know how to manage your symptoms and can tolerate them, you may be accepting unnecessary risk. An asthma diagnosis and discussion with your doctor around your individual circumstances are highly recommended to decide on the best treatment for you.
Guidelines for use
The following are some guidelines for using dual purpose reliever (budesonide/formoterol) medication:
- DuoResp Spiromax and Symbicort Turbuhaler 200/6 can be used to treat asthma symptoms when they happen, as needed, and to help stop asthma symptoms from happening, for instance before exercise. Your doctor will tell you how many inhalations to take before exercising or exposure to other triggers to help stop symptoms from happening or before exposure to other triggers. If you get asthma symptoms, you will be advised to take 1 inhalation of DuoResp Spiromax 200/6 or Symbicort Turbuhaler 200/6 and wait a few minutes. If you do not feel better, take another inhalation.
- Do not use more than 6 inhalations on a single occasion or more than 12 inhalations on any day. If your symptoms continue to worsen over 2-3 days, despite using more inhalations according to your written Asthma Action Plan, make an appointment with your doctor 7,8.
- Symbicort Rapihaler 100/3 can be used to treat asthma symptoms when they happen, as needed, and to help stop asthma symptoms from happening, for instance before exercise. Your doctor will tell you how many inhalations to take before exercising or exposure to other triggers to help stop symptoms from happening.
- If you get asthma symptoms, you will be advised to take 2 inhalations of Symbicort Rapihaler 100/3 and wait a few minutes. If you do not feel better, take another 2 inhalations.
- Do not use more than 12 inhalations on a single occasion or more than 24 inhalations on any day. If your symptoms continue to worsen over 2-3 days, despite using more inhalations according to your written Asthma Action Plan, make an appointment with your doctor9.
DuoResp Spiromax 200/6, Symbicort Rapihaler 100/3 and Symbicort Turbulaher 200/6 are currently the only preventer medications licensed for this use in Australia due to their quick action and evidence of their effectiveness and safety.
If your symptoms don’t improve or worsen despite the use of your reliever or dual purpose reliever as prescribed, seek urgent medical attention.
Rinse your mouth after use
Where possible, rinsing, gargling, and spitting after using any inhaled medication can reduce the risk of side effects in your mouth and throat.
Don’t leave home without it
Carry your dual purpose reliever (budesonide/formoterol) with you as you would your usual reliever puffer. Many people find it helpful to have two inhalers; one at home and one in their bag or on person for use as-needed.
Remember to carry a spacer with you if you are using a metered-dose inhaler like the Symbicort Rapihaler. Using a spacer with metered-dose inhaler devices improves the effectiveness of the medicine and helps to reduce side effects like sore throat, changed voice, and sore mouth. Ask your doctor or pharmacist to explain your device and help you with its use. You can also view our technique videos here.
It is also important to check the expiry date of your medicine and keep track of when you opened it because some inhalers can only be used for a certain number of weeks or months after dispensing or opening.
Maintenance and Reliever Therapy (MART) regime
Even though the MART regime uses the same medication as the available dual purpose reliever (budesonide/formoterol) inhalers, the ‘maintenance’ part of the MART regime – taking your medicine twice daily – is very important for your asthma control and to reduce your risk of asthma flare-ups. If prescribed a MART regime, it is important to continue to use your medicine twice daily.
If you have more questions about your asthma management, we invite you to call one of our Asthma Educators on 1800 ASTHMA (1800 278 462).
Using dual purpose reliever (budesonide/formoterol) for Asthma First Aid
A written Asthma Action Plan contains clear information about what to do when asthma control worsens and it’s important that you follow it. The dual purpose reliever can be used during a sudden asthma attack or flare-up when prescribed by your doctor.
In the case of a severe flare-up or attack and /or if you feel your reliever therapy is not helping, it is important to always call an ambulance on 000 and say you are having a severe asthma attack. Sit upright and stay calm. Keep taking your reliever medicine according to the instructions above until the ambulance arrives.
We’re here to help
If you have any questions about this new treatment option or any other aspects of your asthma wellbeing, our Asthma Educators would welcome your call on 1800 ASTHMA (1800 278 462).
It is important that you discuss your asthma control and treatment options with your doctor or healthcare provider. If your treatment plan changes, ensure that you and your healthcare provider updates your written Asthma Action Plan at the same time.
Asthma Australia does not make specific treatment recommendations. Treatment decisions need to be discussed with your doctor. We aim simply to give you the information you need to have those discussions.
- From eMIMs the bronchodilating effect is dose dependent with an onset of effect within 1 to 3 minutes after inhalation. The duration of effect is at least 12 hours after a single dose.
- https://d8z57tiamduo7.cloudfront.net/resources/Symbicort_Asthma_Action_Plan_Rapihaler_01.06.2020.pdf (NAC website)
- Bateman ED, Reddel HK, O’Byrne PM et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma. N Engl J Med 2018; 378: 1877-87. (Available from: https://www.ncbi.nlm.nih.gov/pubmed/29768147).
- O’Byrne PM, FitzGerald JM, Bateman ED et al. Inhaled combined budesonide–formoterol as needed in mild asthma. N Engl J Med 2018; 378: 1865-76. (Available from: https://www.ncbi.nlm.nih.gov/pubmed/29768149).
- Beasley R, Holliday M, Reddel HK et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med 2019; 380: 2020-30. (Available from: https://www.ncbi.nlm.nih.gov/pubmed/31112386).
- Australian Asthma Handbook V2.0
- Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax. 2004; 59: 94-99. Available from: http://thorax.bmj.com/content/59/2/94.full
- Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2002; Issue 3: CD004107. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004107/full