Can albuterol be used alone without a maintenance inhaler?

@jackiet
Wixela is the generic for Advair. Advair is used as a ongoing treatment for bronchial and lung issues.

I was put on several different medications prior to this one and the did not work. The atrovent actually made my symptoms worse. The Advair (Wixela) worked immediately and have been using it since.

The only instructions I got on it was to use it daily. I was only using it when had flare ups but was told it was designed to prevent flare ups so needed to be done daily. I did not have any side affects to it. I was told about Thrush and to make sure you wash your mouth out immediately after doing the inhaler.

If you look at your Wixela the active ingredients are Fluticasone and Salmeterol. I can actually feel the powder in my bronchial area.

I think important to keep trying something that works for you. I think from your post you are having issues with your provider. Do you live anywhere a Mayo Clinic or Cleveland Clinic. Mayo is in several cities, so is Cleveland Clinic. They have outstanding specialist and a great second opinion program.

@jackiet Hello Jackie - Welcome to Mayo Connect, as a fellow asthma patient, let me try to answer as best I can.
You have discovered one of the conundrums of modern medicine when you ask "And why would a PCP prescribe albuterol alone?" For nearly 50 years albuterol and other short-acting beta-agonists (SABA) were the drug of choice for treating asthma, and they were pretty good at stopping an asthma attack. In fact, that is all they did - stop the immediate attack, not treat the underlying inflammation. And pretty much, unless you were a pulmonologist, for a long time it was the only tool in your toolbox.

Maybe 30-40 years ago, science was learning that asthma was more than airway constriction, it was inflammation too. They started treating moderate-severe asthma with corticosteroids - at first these were oral, and taken only during an exacerbation. Then they added a nebulized type(ICS), and usually only during an exacerbation - but some pulmonologists realized their patients were doing better, needing less "rescue" from their albuterol and having fewer hospitalizations. So soon prescribed ICS were prescribed full-time for people with moderate to severe asthma.

As early as 2012, I was encouraged to change to Advair, a powdered inhaler similar to Wixela - I was unable to tolerate that version. Beginning in about 2017, forward looking lung docs began prescribing the dual inhaler Symbicort, previously used for COPD, for chronic asthma. Insurers balked at the higher cost, but eventually relented for those who were using a rescue inhaler containing Albuterol several times a week or experiencing numerous exacerbations.

In 2020 and 2022 advanced guidelines came out in support of the use of dual inhalers for asthma control:
https://ginasthma.org/wp-content/uploads/2020/04/Main-pocket-guide_2020_04_03-final-wms.pdf
and the harder to wade through study:
https://link.springer.com/article/10.1186/s13223-020-00472-8
What is the danger of continuing albuterol? High use of albuterol correlates to higher risk of death from asthma, as reported in Springer, " UK registry data have recently suggested SABA overuse or overreliance may be linked to asthma-related deaths: among 165 patients on short-acting relievers at the time of death, 56%, 39%, and 4% had been prescribed > 6, > 12, and > 50 SABA inhalers respectively in the previous year [21]. Registry studies have shown the number of SABA canisters used per year to be directly related to the risk of death in patients with asthma. Conversely, the number of ICS canisters used per year is inversely related to the rate of death from asthma, when compared with non-users of ICS [8, 22]. Furthermore, low-dose ICS used regularly are associated with a decreased risk of asthma death, with discontinuation of these agents possibly detrimental [22]."

That statistic frightened me - before my switch to Symbicort, I was using 10-12 inhalers per year! Especially after my next door neighbor died of an asthma attack in the hospital parking lot with his rescue inhaler in
his hand. If you use a typical 120 dose inhaler, 2 puffs a day, you are using 6 inhalers a year - more if you need it for rescue from an asthma attack. And you are not addressing the underlying cause of the asthma - the inflammation.

My pulmonologist, a bronchiectasis and MAC specialist, says it is a risk-benefit analysis. Keeping asthma and inflammation under control helps keep bronchiectasis from getting worse. Here is what I wonder - if my inflammation was treated 30-40 years ago, would I even have developed bronchiectasis?

So, why would a Primary Care Provider prescribe Albuterol alone? Habit - it is what they have always done, and unless they have studied the latest protocol for treating asthma, they don't know the new developments.

What is the alternative? First, my pulmonologist is using the lowest dose of Symbicort (actually, I use a generic version called Breyna) that manages my asthma day-to-day. This lowers the risk of the ICS promoting infection. The downside? When I get a respiratory infection - like when I had Covid last month - I still have to take oral steroids for a short time.

Maybe you can check to see if you can get Breyna, or another generic version of Symbicort approved.

Thank you for your advice. I appreciate it.

Sue: I'm grateful for your reply. I am working on this from a number of different angles. Your explanation of albuterol really helps. When I was taking Symbicort, and then Wixela, I had hardly any need for the albuterol because the ICS seemed to take care of everything. I have never used it every day and would not. So I'm thinking of possibly using it infrequently (they say no more than two or three times a week) only if I need it, since it's all I have right now until I get to see a pulmonologist again.

I stopped the Wixela on June 6 and I was perfectly fine for about three months, after which symptoms started showing up. Maybe an on again, off again ritual would work.

I guess if I have to take a corticosteroid again I'll have to. But I've read about the danger for people my age. And I'm trying to stay alive a little longer.

Thanks again!

Jackie Trace

I just talked about stopping Advair with my doc Wednesday. I have mild asthma along with mild bronchiectasis, but a couple of severe pollen allergies. I cough rather than wheeze and it seemed like a miracle drug when I started it because the nagging cough was GONE in 24-36 hours. I was a mess at that time with under treated allergies and a lot of secretions. Nasal sprays were also changed.
I just had Covid and had to be off the Advair during Paxlovid. I didn’t start coughing. I am also on a steroid nasal spray and steroid sinus rinse. Like you, I’d love to decrease the steroids, but have to keep post nasal drip under control (possible cause of my bronchiectasis). Since I didn’t start coughing, I asked about stopping Advair over winter. Doc said Advair needs to be taken regularly, but Symbicort can be used (regularly not a day or two) during flare ups and ordered that. I noticed he ordered 12 refills, so I think he expects me to need it pretty regularly and I’ll certainly take it to keep cough under control.
One thing to keep in mind is that keeping asthma under control is easier than regaining it. Also, systemic steroids (pills or IV’s) are much riskier than the inhalers and topical ones. Good luck!

Your asthma seems a lot like mine. On the mild side with cough but no wheezing. Except that I don't have the bronchiectasis, at least as far as I know. I need to look that one up. I also am allergic to pollen, perfume, etc. I started taking Allegra every day, which seems to help somewhat. I think it helps with post nasal drip, as I haven't had much of a problem with that lately.

It seems that Symbicort is better than Advair for you. I think it was better for me than the Wixela but I can no longer get it. (Advair = Wixela, I'm not sure.) And thanks for confirming that the inhalers don't put the steroids into your system like the pills and topicals. Albuterol, if I'm correct, is not a steroid inhaler.

So right now, before I find a pulmonologist I will take a puff or two of albuterol if I need it, as long as it's not more than a couple of times a week. I feel that might be safe. And if a lung doctor tells me I need the ICS maybe I can talk them into 100 mg instead of the 500 mg they initially prescribed. I should think the side effects would be milder. Though what do I know. I really appreciate your feedback and wish you the best of luck in battling your asthma.