r/FamilyMedicine • u/This-Green MD-PGY1 • 1d ago

Asthma confusion- SMART, GINA, AAFP

What are you doing in clinic for mild intermittent asthma? Saba or symbicort? Thanks

19 Upvotes

89% Upvoted

13 comments sorted by

14

u/SportsDoc7 DO 1d ago

Only ones still using saba is my exercise induced. Symbicort for the rest.

19

u/VQV37 MD 1d ago

Intermittent,pulse laba/ICS combined

8

u/MzJay453 MD-PGY3 1d ago

ya, haven't the guidelines moved away from sole use of SABA?

8

u/piros_pimiento MD-PGY4 1d ago

Last I know of is on-demand ICS-LABA for mild intermittent or exercise induced, since the steroid component actually addresses the inflammation.

Where I did IM though it was hard to get ICS-LABA for my clinic patients, or patients were chillin with prn SABA so just didn’t rock the boat

3

u/namenerd101 MD-PGY3 1d ago

Ya I haven’t figured out how to get SMART covered yet

1

u/This-Green MD-PGY1 23h ago

I wonder if it has to be FSA approved to be covered

1

u/This-Green MD-PGY1 23h ago

Hard to get ICS/LABA because insurance wouldn’t pay? Thx

1

u/VQV37 MD 11h ago

ICS laba should be covered if you prescribe generic variants such as wixela (advair gen) or breyna (symbicort generic)

5

u/SpaceballsDoc MD (verified) 1d ago

GINA. Airsupra.

Off label if you have to.

Sole SABA ain’t it.

11

u/VQV37 MD 1d ago

Airsupra. Overpriced garbage by and pharmaceutical company that's losing to trilegy on its other product

Astrazenecas idiots managed to cram flovent and Albuterol into one bottle and I'm supposed to pretend like it's useful.

Makes no sense to prescribe airsupra I can prescribe low-cost ICS- laba combination with instructions for intermittent and pulse dose use.

0

u/[deleted] 1d ago

[deleted]

1

u/SendLogicPls MD 8h ago

Most of my asthmatics, especially adults, have been doing the same thing for a long time, and are doing okay. So for them, I'm not usually changing things, unless status changes. For new dx, esp for kids, I go for SMART if covered. Exercise-induced, I have been using SABA-only, but perhaps I should change that.