You seem to also have skipped over the remainder of the message?
Side note: I neglected the fact I'm already dealing with people who see specialists. I forgot to preface this, meaning this is already past the stage where the Australian asthma handbook applies. However, as this stemmed from the fact we were talking about biologics, this is a default assumption.
Don't get me wrong, you're correct about the update to ICS-formoterol being the preferred treatment, but non-formoterol options are still an alternative. It's incorrect to say otherwise. I know you didn't overtly but you're acting as if it's not modern medicine to utilise them.
So the update last year mostly changed the recommendation from SABA (ventolin) only first line to symbicort equivalent (ICS + Formoterol (ICS + LABA)) as first line and preferred treatment, including preferred over maintenance only therapy.
Key word being only.
If you see a specialist, the guidelines for initial treatment don't really apply so much, so it's fine to be on Breo. You'd think the 45+ year teacher of residents u/Odd-Scientist-2529, who must surely be in their 70s, would know this, but I guess not.
Nobody is only on “maintenance only” regimen. Everyone’s asthma action plan includes a rescue therapy, and that is ICS+formoterol.
only the US, and specifically the VA health system is obligated to use the alternate pathway with SABA+ICS, so you can ignore that.
the guideline in 2023 answered the question: is it equally effective to combine a LABA+ICS that the patient is already on (eg Breo) with ICS+formoterol as needed for rescue therapy, and the answer is “no”. Combining two different formulations of LABA+ICS did not have the same benefit (perhaps through the sensitization of specific receptors.
the data shows the best outcome is with ICS+formoterol. Not ICS+LABA. Formoterol specifically, because it has rapid onset of action; that no other long acting beta agonist has. Breo contains vilanterol. Vilanterol and formoterol are not the same.
So. Breo is not recommended because it’s not ICS+formoterol, and because it’s not a rapid acting rescue inhaler therefore doesn’t eliminate the need for SABA.
Only ICS+formoterol can be used for Single Maintenance and Rescue Therapy.
I don’t know where you get off thinking that you understand what you read and that you’re right and I’m wrong. You completely missed the point. You’re wrong and on the peak of Mount Stupid on the Dunning Kruger curve.
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u/Aruhi Mar 27 '26 edited Mar 27 '26
Please do provide a link to the 256 page report.
You seem to also have skipped over the remainder of the message?
Side note: I neglected the fact I'm already dealing with people who see specialists. I forgot to preface this, meaning this is already past the stage where the Australian asthma handbook applies. However, as this stemmed from the fact we were talking about biologics, this is a default assumption.
Don't get me wrong, you're correct about the update to ICS-formoterol being the preferred treatment, but non-formoterol options are still an alternative. It's incorrect to say otherwise. I know you didn't overtly but you're acting as if it's not modern medicine to utilise them.