Twelve- and 52-week safety of albuterol multidose dry powder inhaler in patients with persistent asthma

Safety outcomes of salbutamol: A systematic review and meta-analysis

PURPOSE

Salbutamol has been used to alleviate bronchospasm in airway disease for decades, while its potential risks have not been systematically investigated yet. The risk of any potential adverse events (AEs) in patients treated with salbutamol was assessed through systematic review and meta-analysis.

METHODS

A systematic search of the literature was conducted, using EMBASE, PubMed and Cochrane library, until 3 April 2023. Once the AE incidence was evaluated, randomized controlled trials (RCTs) were eligible for review. The endpoints included the incidence of total AEs, severe AEs, treatment discontinuation and specific AEs. The pooled AEs incidence was analysed via random-effects model in a single-arm meta-analysis. A subgroup study was carried out to examine whether the pooled incidence of AE differed by indications or formulations.

RESULTS

Of the 8912 studies that were identified, 58 RCTs met the inclusion criteria and involved 12 961 participants. The analysis showed the pooled incidences of total AEs, severe AEs and treatment discontinuation in patients treated with salbutamol were 34%, 2% and 3%, respectively. Subgroup analysis indicated that premature labour users and intravenous salbutamol users were more likely associated with total AEs. The most frequently observed specific AEs were palpitations or tachycardia.

CONCLUSION

This meta-analysis indicated that salbutamol was associated with a very common risk of palpitations or tachycardia. Clinical vigilance and research efforts are needed to optimize the safe use of salbutamol.

Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement

Rationale: For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access.Objectives: To provide policy recommendations and outline steps for passing and implementing stock albuterol laws.Methods: We assembled a diverse stakeholder group and reviewed guidelines, literature, statutes, regulations, and implementation documents related to school-based medication access. Stakeholders were divided into two groups-legislation and implementation-on the basis of expertise. Each group met virtually to review documents and draft recommendations. Recommendations were compiled and revised in iterative remote meetings with all stakeholders.Main Results: We offer several recommendations for crafting state legislation and facilitating program implementation. 1) Create a coalition of stakeholders to champion legislation and implement stock albuterol programs. The coalition should include school administrators, school nurses and health personnel, parents, or caregivers of children with asthma, pediatric primary care and subspecialty providers (e.g., pulmonologists/allergists), pharmacists, health department staff, and local/regional/national advocacy organizations. 2) Legislative components critical for effective implementation of stock albuterol programs include specifying that medication can be administered in good faith to any child in respiratory distress, establishing training requirements for school staff, providing immunity from civil liability for staff and prescribers, ensuring pharmacy laws allow prescriptions to be dispensed to schools, and suggesting inhalers with valved holding chambers/spacers for administration. 3) Select an experienced and committed legislator to sponsor legislation and guide revisions as needed during passage and implementation. This person should be from the majority party and serve on the legislature's health or education committee. 4) Develop plans to disseminate legislation and regulations/policies to affected groups, including school administrators, school nurses, pharmacists, emergency responders, and primary/subspecialty clinicians. Periodically evaluate implementation effectiveness and need for adjustments.Conclusions: Stock albuterol in schools is a safe, practical, and potentially life-saving option for children with asthma, whether asthma is diagnosed or undiagnosed, who lack access to their personal quick-relief medication. Legislation is imperative for aiding in the adoption and implementation of school stock albuterol policies, and key policy inclusions can lay the groundwork for success. Future work should focus on passing legislation in all states, implementing policy in schools, and evaluating the impact of such programs on academic and health outcomes.

Pharmacokinetics, pharmacodynamics, and clinical efficacy of albuterol RespiClick(™) dry-powder inhaler in the treatment of asthma

INTRODUCTION

Incorrect use of inhaler devices by patients with asthma is common and can adversely affect clinical outcomes. Devices that are straightforward to use are less likely to result in dosing errors and can improve patients' satisfaction with therapy and adherence. A novel dry-powder formulation of the rescue bronchodilator albuterol (salbutamol) administered using a multidose dry-powder inhaler (mDPI; RespiClick™) has recently been approved in the USA.

AREAS COVERED

Studies on the albuterol mDPI were identified in searches of PubMed and www.clinicaltrials.gov . Pharmacokinetic, pharmacodynamic, efficacy, and safety data, and patients' experiences with the albuterol mDPI are presented.

EXPERT OPINION

The albuterol mDPI has an efficacy/tolerability profile consistent with other inhaled forms of albuterol, and is reliable, easy to use, and associated with a high level of patient satisfaction. This is the first albuterol dry-powder inhaler (DPI) to become available in the USA, with most other formulations being delivered using a pressurized metered-dose inhaler (pMDI). The availability of a breath-actuated device avoids the challenge of coordinating actuation and breathing when using pMDIs, and could simplify treatment for patients also using a DPI for controller medication. Additional features of RespiClick, such as an integrated dose counter and minimal pre-inhalation preparation, facilitate its use.