Asthma is a chronic, inflammatory lung condition affecting over 262 million people worldwide and more than 25 million Americans alone.
Treatment should focus on controlling symptoms that may be debilitating; severe exacerbations of asthma symptoms, known as exacerbations, can even be fatal; current therapy for asthmatics involves inhaled corticosteroids to reduce inflammation while short-acting beta2-agonists relax lung muscle spasms to make breathing easier.
Budesonide belongs to the class of medications known as steroids and works to decrease airway swelling while Albuterol falls into another group called bronchodilators that work by relaxing muscle relaxation and opening air passages. Together these medications form a fixed dose combination pill taken as needed by users with mild asthma symptoms.
Researchers of the DENALI trial (Determining Asthma Exacerbation Risk with Budesonide/Formoterol) concluded that as-needed rescue treatments such as Budesonide-Formoterol proved more effective at lowering annualized rates of severe asthma exacerbations than albuterol alone; higher-dose combination groups had a 26% reduced risk for severe exacerbations than those taking albuterol alone alone.
This study was published in the New England Journal of Medicine. Pulmonology Advisor will feature reports and updates from American Thoracic Society International Conference being held this weekend in Dallas, Texas.
Albuterol vs. Budesonide: Understanding the Differences for Asthma Treatment
Albuterol: Quick Relief Inhaler
Albuterol is a widely used rescue inhaler that provides rapid relief from symptoms associated with asthma or chronic obstructive pulmonary disease (COPD). Its primary function is to relax the muscles in the airways, facilitating easier breathing. Albuterol is typically employed on an as-needed basis, specifically when symptoms arise.
Budesonide: Daily Maintenance Inhaler
Contrarily, budesonide is an inhaler prescribed for daily use, regardless of symptom occurrence.
This corticosteroid works by reducing inflammation in the airways, effectively preventing symptoms from emerging. It is important to note that budesonide is not intended for immediate relief during sudden asthma or COPD episodes and should not be used as a rescue inhaler.
Comparing Effectiveness: Albuterol and Budesonide
Multiple studies have assessed the efficacy of albuterol and budesonide in treating asthma. One notable study discovered that a combination of budesonide and formoterol (another medication) proved superior to albuterol in preventing asthma exacerbations.
Additionally, a different study determined that a fixed-dose combination of albuterol and budesonide exhibited greater efficacy as a rescue medication than albuterol alone.
However, some studies have found no substantial differences between the two medications.
Long-Term Asthma Management: Budesonide’s Advantage
For long-term asthma management, budesonide emerges as the more effective option compared to albuterol. Budesonide’s ability to reduce inflammation in the airways aids in preventing symptom occurrence.
On the other hand, albuterol primarily serves as a fast-acting relief measure by relaxing the airway muscles. It is typically reserved for immediate symptom relief on an as-needed basis.
A study published in BMJ Open Respiratory Research specifically examined two fixed-dose combinations of albuterol/budesonide alongside albuterol alone. This study focused on adults and children aged four years and above with moderate-to-severe asthma.
The results indicated that the albuterol/budesonide combination proved more effective for long-term asthma management compared to albuterol alone.
Consulting a Healthcare Provider for Individualized Treatment
Ultimately, the choice between albuterol and budesonide, or any other medication, should be made in consultation with a healthcare provider. The decision depends on the individual’s specific condition and needs. Healthcare professionals possess the expertise to guide patients towards the most appropriate treatment plan for their asthma management.
Other Things to Know
Mechanism of Action
Budesonide, an inhaled glucocorticoid that acts as an anti-inflammatory, is prescribed to manage respiratory conditions such as asthma or COPD.
This drug works by binding to effector cells of the immune system and modulating their activity, and also preventing inflammation-producing genes from being produced via inhibited gene transcription, providing effective relief both from their cause as well as symptoms. It provides effective solutions to both inflammation as well as symptoms associated with asthma.
Budesonide can be combined with levalbuterol, a beta2-agonist. When taken together they quickly relieve symptoms of bronchoconstriction by relaxing airways to allow more oxygen into lungs with reduced resistance. Budesonide comes as a fast-acting, preservative-free pMDI formulation known as rescue inhaler and requires a valid valid prescription from your healthcare provider to access.
Budesonide should be avoided by pregnant women and individuals suffering from glaucoma or cataracts since this could increase pressure inside their eyes; additionally more of it stays inside bodies, increasing risks for side effects associated with longer treatment duration of side effects or increased risks for side effects or side effects associated with side effects of exposure.
DENALI trial results demonstrated that using an inhaler containing both albuterol and budesonide significantly reduced risk for severe asthma exacerbations compared to using albuterol alone, using an intention-to-treat analysis with 87% power to detect such reduction at two-sided significance level of 5%.
Effectiveness
Budesonide works by decreasing swelling and irritation in the airways, which allows for easier breathing. It can help alleviate symptoms of asthma like difficulty breathing, chest tightness, wheezing and coughing as well as treat sudden episodes of difficulty breathing and coughing (known as asthma attacks).
Budesonide can be taken in pill form or liquid form or inhaled through an aerosol spray; adults and children of all ages can use this medicine; Pulmicort is available as a brand name of its spray form.
Budensonide is an extremely potent corticosteroid medication, 100 times stronger than prednisolone. Absorption occurs through small intestinal and proximal colon absorption routes and first-pass metabolism to produce 6b-hydroxybudesonide and 16a-hydroxyprednisolone, two active glucocorticoids with limited systemic effects.
At the American Thoracic Society 2019 International Conference, a study presented at PT027 combination therapy was compared with albuterol alone for treating patients with mild asthma who were receiving low dose maintenance ICS therapy.
Results demonstrated that it significantly outperformed its counterpart in terms of risk reduction of severe asthma exacerbations when added as rescue medicine, changes to lung function as measured by forced expiratory volume in one second (FEV1) measurement and health-related quality of life measures.
Side Effects
Clinical trials conducted with albuterol/budesonide pMDI proved its safety profile was acceptable and helped prevent severe asthma exacerbations more effectively than placebo. Preplanned time-to-event analysis indicated that the annualized rate of severe asthma exacerbations was significantly reduced among both higher dose combination groups compared with albuterol alone group.
As was observed with death rates prior to hospital discharge, combination groups experienced lower death rates compared with albuterol-only groups.
Oropharyngeal candidiasis was observed in 0.6%, 0.3% and 0.1% of patients taking high-dose combinations; 0.3% in low-dose combinations groups; and 0% of those on albuterol alone alone groups respectively; dysphonia also occurred frequently (0.3% in high dose combinations group, 0.4% in low dose combination groups and none at all in albuterol only groups respectively).
As it may make managing blood pressure harder, beta blockers should also be informed if other medications such as beta-agonists have been taken, including blood pressure drugs called beta blockers that could interfere with their effects. It’s also essential to inform your physician if you have diabetes as albuterol may make managing blood sugar harder.
Levalbuterol can cause paradoxical bronchospasm, in which symptoms worsen instead of improving. If this occurs, therapy must be discontinued and another medication taken instead.
As its effect on breast milk production remains unknown, if breastfeeding or planning on breastfeeding it’s recommended that you discuss it with your healthcare provider first.
