{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T22:56:06Z","timestamp":1788044166086,"version":"build-2784847793"},"reference-count":12,"publisher":"American Society of Consultant Pharmacists","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["sr care pharm"],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:p>The first combination inhaled corticosteroid and short-acting beta<jats:sub>2<\/jats:sub> agonist (ICS-SABA) was approved by the Food and Drug Administration (FDA) in 2023 for as-needed treatment or prevention of bronchoconstriction and to reduce the risk of asthma exacerbations in patients 18\n years of age and older. The recently approved product contains an ICS-albuterol combination. The 2024 Global Initiative for Asthma (GINA) guidelines recommend as-needed ICS-formoterol as the preferred asthma reliever therapy; however, a GINA alternative recommendation is the use of ICS whenever\n an as-needed (SABA) is used. There is no difference in as-needed asthma treatment recommended by the GINA guidelines in older adults, and there has been minimal study in older adults. Because of limited guidance on the use of the ICS-SABA reliever inhaler in older adults, the purpose of this\n review is to evaluate the DENALI and MANDALA studies and the potential role of ICS-SABA in older adults. The mean ages in both studies were 50 years. The MANDALA primary outcome result was a statistically significant lower risk of severe exacerbations in the ICS-SABA reliever group compared\n with the as-needed albuterol (ALB) group at 24 weeks. In the MANDALA older adults subgroup analysis, there was not a statistically significant difference in the ICS-SABA reliever group compared with the as-needed ALB-alone group but the results favored ICS-SABA. The DENALI primary outcome\n results were a greater change from baseline in forced expiratory volume in the first second (FEV1) area under the curve averaged over 12 weeks with albuterol\/budesonide (ALB-BUD) 180\/160 ug compared with budesonide alone and placebo and a greater change from baseline in trough FEV1 with ALB-BUD\n 180\/160 ug and 180\/80 ug than ALB-alone and placebo. Because of minimal adverse effects in both trials and the benefits in preventing asthma exacerbations reported in the MANDALA trial, it is important to assess and recommend that older adults with asthma receive inhaled corticosteroid with\n their reliever asthma inhaler.<\/jats:p>","DOI":"10.4140\/tcp.n.2025.3","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T04:31:08Z","timestamp":1735878668000},"page":"3-9","source":"Crossref","is-referenced-by-count":2,"title":["Combination Inhaled Corticosteroid and Short-acting Beta2 Agonist (ICS-SABA) Use for Older Adults With Asthma"],"prefix":"10.4140","volume":"40","author":[{"given":"Jaycie","family":"Truong","sequence":"first","affiliation":[{"name":"1 University of Texas Medical Branch\u2014Correctional Managed Care, Huntsville, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A. B.","family":"Cauthon","sequence":"additional","affiliation":[{"name":"2 Feik School of Pharmacy, University of the Incarnate Word, San Antonio, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2625","reference":[{"key":"ref1","article-title":"Epidemiology of asthma in children and adults","year":"2019","journal-title":"Frontiers."},{"key":"ref2","doi-asserted-by":"crossref","first-page":"04052","DOI":"10.7189\/jogh.12.04052","article-title":"Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study","volume":"12","year":"2022","journal-title":"J Global Health."},{"key":"ref3","journal-title":"Asthma as the Underlying Cause of Death"},{"key":"ref4","article-title":"GINA Main Report.","year":"2024","journal-title":"Global Strategy for Asthma Management and Prevention"},{"issue":"4","key":"ref5","doi-asserted-by":"crossref","first-page":"1901872","DOI":"10.1183\/13993003.01872-2019","article-title":"Overuse of short-acting beta-2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme","volume":"55","year":"2020","journal-title":"Eur Respir J."},{"key":"ref6","volume-title":"Drug Combination Treatment for Adults With Asthma","year":"2023"},{"key":"ref7","volume-title":"AIRSUPRA\u00ae package insert","year":"March 2024"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1513\/AnnalsATS.201608-658ST","article-title":"An official American Thoracic Society workshop report: evaluation and management of asthma in the elderly","volume":"13","year":"2016","journal-title":"Ann Am Thorac Soc."},{"issue":"22","key":"ref9","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1056\/NEJMoa2203163","article-title":"Albuterol-budesonide fixed-dose combination rescue inhaler for asthma","volume":"386","year":"2022","journal-title":"N Engl J Med."},{"issue":"3","key":"ref10","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.chest.2023.03.035","article-title":"Albuterol-budesonide pressurized metered dose inhaler in patients with mild-to-moderate asthma: results of the DENALI double-blind randomized controlled trial","volume":"164","year":"2023","journal-title":"Chest"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.jaip.2023.10.027","article-title":"Regulatory and insurance challenges must be overcome in the United States to meet global standards for asthma management","volume":"12","year":"2024","journal-title":"J Allergy Clin Immunol Pract."},{"issue":"4","key":"ref12","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1164\/rccm.202209-1729PP","article-title":"A call for the United States to accelerate the implementation of reliever combination inhaled corticosteroid-formoterol inhalers in asthma","volume":"207","year":"2023","journal-title":"Am J Respir Crit Care Med."}],"container-title":["The Senior Care Pharmacist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ingentaconnect.com\/content\/ascp\/tscp\/2025\/00000040\/00000001\/art00002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T04:31:28Z","timestamp":1735878688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ingentaconnect.com\/content\/10.4140\/TCP.n.2025.3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1,1]]}},"alternative-id":["2639-9636(20250101)40:1L.3;1-"],"URL":"https:\/\/doi.org\/10.4140\/tcp.n.2025.3","relation":{},"ISSN":["2639-9636"],"issn-type":[{"value":"2639-9636","type":"print"}],"subject":[],"published":{"date-parts":[[2025,1,1]]}}}