Lauren Howell, PharmD
For years, patients with asthma have been prescribed regimens that include several different inhalers, requiring them to remember the correct timing and situation for using each one. The development of combination inhalers has allowed patients to carry fewer inhalers and has significantly simplified regimens. While combination inhalers are not necessarily new, Airsupra (AstraZeneca) is the first and only rescue inhaler that is approved to treat symptoms of asthma, including airway tightening, and to help prevent asthma attacks.
How it works and recommended dosage
Airsupra is a combination of a beta2 adrenergic agonist called albuterol and a corticosteroid called budesonide. Albuterol works to combat the symptoms of asthma by relaxing the smooth muscles of airways while budesonide works to decrease inflammation and prevent future attacks.
Airsupra is packaged as a pressurized metered dose inhaler that delivers 90 µg of albuterol and 80 µg of budesonide per actuation. The recommended dosage is 2 actuations (180 µg albuterol/160 µg budesonide) by oral inhalation as needed for asthma symptoms. No more than 6 doses or 12 inhalations should be used in a 24-hour period.
Drug interactions
Airsupra should be used with caution in combination with strong CYP3A4 inhibitors, as this may cause systemic corticosteroid effects. Additionally, Airsupra should be used judiciously with other short-acting beta agonists. If a patient is taking a beta-blocker, the effectiveness of Airsupra may be decreased and severe bronchospasm may occur.
In patients using Airsupra, consider alternatives to beta-blockers and if no alternative is available, consider the use of a cardioselective beta-blocker. The use of Airsupra with diuretics may potentiate hypokalemia or ECG changes. If used with digoxin, serum digoxin levels may be decreased. Use Airsupra with extreme caution if using concomitantly with monoamine oxidase inhibitors or tricyclic antidepressants.
Adverse effects and contraindications
Airsupra is contraindicated in patients with a hypersensitivity to albuterol, budesonide, or to any of the excipients. The most common adverse reactions in patients using Airsupra are headache, oral candidiasis, cough, and dysphonia. In patients with hepatic impairment, systemic exposure to budesonide may increase. Cardiovascular effects may occur so use with caution in patients sensitive to sympathomimetic drugs and patients with cardiovascular disorders. Use with caution in patients with convulsive disorders, hyperthyroidism, diabetes mellitus, and ketoacidosis. Hypokalemia may occur. Use with caution in patients with potential of worsening infections. Monitor patients with major risk factors for decreased bone mineral content. Glaucoma and cataracts may occur.
Clinical trials
The efficacy of Airsupra was evaluated in both the MANDALA and DENALI trials. MANDALA was a phase III, randomized, double-blind, multicenter, parallel-group, event-driven trial. In MANDALA, treatment with Airsupra, compared to treatment with albuterol alone, demonstrated significantly reduced risk of severe asthma exacerbations as assessed by the time to first severe asthma exacerbation. There were reductions in severe asthma exacerbation risk regardless of exacerbation history, baseline lung function, and asthma severity. Treatment with Airsupra resulted in a reduction in the annual rate of asthma exacerbations by 24% compared with the treatment group that received albuterol alone.
DENALI was a phase III, randomized, double-blind, placebo-controlled, multicenter, parallel-group trial that was designed to evaluate the efficacy and safety of Airsupra compared to its components on improvement in lung function. In this trial, Airsupra demonstrated a statistically significant improvement in lung function measured by forced expiratory volume in one second, compared to the individual components albuterol and budesonide, and compared to placebo. Onset of action and duration of effect were similar for both Airsupra and albuterol. The safety and tolerability of Airsupra was consistent with the known profiles of the components.
Patient counseling
Patients should be advised to seek medical attention immediately if treatment with Airsupra becomes less effective for symptomatic relief or if symptoms become worse. Additionally, patients should be advised not to exceed 6 doses in a 24-hour period. Patients should be instructed to prime the inhaler before using for the first time, when the inhaler has not been used for more than 7 days, is dropped, or after cleaning, and to shake well before each spray. Advise patients to rinse the mouth with water, if available, without swallowing after inhaling Airsupra to help reduce the risk of thrush. ■