Your doctor may prescribe these as-needed to decrease shortness of breath. Combined ICS/LABA treatment is essential in patients with asthma due to the increased mortality risk associated with LABA monotherapy. ICS+LABA vs LABA16 Effect of adding ICS to LABA 14 RCTs, N=11,794 Exacerbations: number of people with one or more LABA = 47 per 100 vs ICS+LABA = 42 per 100 12 months (median) OR 0.83, 95%CI 0.70-0.98 SS Moderate quality 6 RCTs, N=3357 Mortality NS(all cause) OR 0.92, 95%CI 0.76-1.11 Moderate quality 10 RCTs, N=10,681 Notes: agonist (LABA), are common starting points in step-down therapy. Preferred SABA as needed Low-dose ICS Medium-dose ICS Medium-dose ICS + LABA or montelukast High-dose ICS + LABA or montelukast High-dose ICS + Oral corticosteroids + LABA or montelukast Alternative Cromolyn or montelukast 0 – 4 Years Patient education and environmental control at each step. SABA RELIEVERS Bricanyl Turbuhaler † ^ terbutaline 500mcg Airomir Autohaler ‡ ^ salbutamol 100mcg Asmol Inhaler † ^ salbutamol 100mcg Ventolin Inhaler † ^ salbutamol 100mcg Atrovent |Metered Aerosol † ^ ipratropium 21mcg ICS/LABA COMBINATIONS LAMA MEDICATIONS LAMA/LABA COMBINATIONS ICS/LAMA/LABA SAMA MEDICATION Seretide MDI ‡ SABA plus SAMA: shown to be more effective than either component alone in improving symptoms and forced expiratory volume in one second (FEV 1). LAMA LABA plus LAMA: also more effective than either component alone, improving symptoms, FEV 1 and reducing the risk of exacerbations. Long-acting β adrenoceptor agonists (LABAs, more specifically, long-acting β 2 adrenergic receptor agonists) are usually prescribed for moderate-to-severe persistent asthma patients or patients with chronic obstructive pulmonary disease (COPD). SABA Short-acting beta-agonist ICS+LABA COMBO Combination ICS Inhaled corticosteroid ICS+LABA accounts for almost a quarter of all inhaled respiratory medications in Canada and is the second most prescribed in its drug class. For patients with moderate or severe asthma, the ICS-LABA may be used as both maintenance (daily) preventive treatment, and also as a rescue inhaler, with extra inhalations taken for breakthrough asthma symptoms as needed. The ICS-LABA inhaler replaces albuterol as a rescue inhaler. Ipratropium should be withdrawn before initiating a LAMA and a SABA prescribed for as-needed symptom relief. Explain to patients that a SAMA and a LAMA should not be taken concurrently. Short-Acting Bronchodilators (Short acting beta agonists, SABA & short-acting muscarinic antagonists, SAMA) These medications work quickly (within 15-20 minutes) to help decrease shortness of breath. Medications: SABA, oral systemic corticosteroids; consider starting ICS* Referral to follow-up care Asthma discharge plan Review of inhaler technique and, whenever possible, environmental control measures *Abbreviations: EIB, exercise-induced bronchospasm; ICS, inhaled corticosteroid; LABA… Inhaled SABA… They may also be prescribed before exercise. Rescue Medication •SABA as needed for symptoms. Many studies have shown the benefit of this approach, and a recent meta-analysis concluded that replacing SABA with fast-acting LABA/ICS reliever therapy results in a one-third reduction in risk of severe exacerbations and a 25% reduction in risk when compared with double the baseline maintenance ICS/LABA and SABA treatment . The use of ICS+LABA combination products has increased approximately 13% over the past 4 years.

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