Inhaler drug classes and devices (ICS, SABA, LABA, MART)

What it is

Asthma medications split into relievers and controllers. Relievers are bronchodilators with a rapid onset of action:

• SABA, short acting beta agonist: salbutamol, sold as Ventolin
• SAMA, short-acting muscarinic antagonist: ipratropium bromide, sold as Atrovent
• The anti-inflammatory reliever: ICS-formoterol

Controllers:

• ICS, the cornerstone of asthma treatment
• LABA, long-acting beta agonist, which is always combined with ICS. Formoterol is the only LABA that has a rapid onset of action, so it can be used as a reliever, and it is combined with an inhaled corticosteroid in the same device
• LAMA, long-acting muscarinic antagonist
• Leukotriene receptor antagonist
• Theophylline, a bronchodilator with a minimal effect and a narrow therapeutic index
• Biological agents: anti-IgE, anti-IL5/R, anti-IL4R

MART is the name for the arrangement in which ICS-formoterol serves as both maintenance and reliever. The devices carry the same drugs under trade names. MDI stands for metered-dose inhaler. Fluticasone is given as an ICS by MDI, salbutamol as a SABA by MDI, and fluticasone with salmeterol is the ICS plus LABA pair. Flixotide holds fluticasone propionate at 50 mcg per actuation as a metered dose inhaler. Seretide, made both as an inhaler and as a Diskus, holds salmeterol xinafoate with fluticasone propionate. Ventolin holds salbutamol. Doses are counted in puffs and set by weight. Salbutamol by MDI: under 20 kg, 5 puffs, which is 2.5 mg; above 20 kg, 10 puffs, which is 5 mg. Ipratropium bromide by MDI: under 20 kg, 3 puffs, 0.25 mg; above 20 kg, 6 puffs, 0.5 mg. Examples of these asthma medications by group are: SABA: albuterol, and Xopenex, that is levalbuterol. ICS: fluticasone, budesonide and beclomethasone. ICS with LABA: fluticasone with salmeterol, sold as Advair, and budesonide with formoterol, sold as Symbicort. Leukotriene antagonists: montelukast and zafirlukast. Anticholinergic with SABA: ipratropium with albuterol, sold as DuoNeb. Anticholinergic with LABA: tiotropium with olodaterol, sold as Stiolto. So an inhaler holding budesonide and formoterol is an inhaled corticosteroid with a long-acting beta agonist, and not an anticholinergic and not a leukotriene antagonist.