Dr. Howard Smith Oncall

  Vidcast:  https://youtu.be/3EF1xXDxb28   When asthmatics develop oxygen-robbing attacks, rescue with inhaled therapy that includes not only albuterol but also a steroid is 26% more effective than treatment with the bronchodilator albuterol alone.  The randomized, double-blind multicenter MANDALA study followed a group of 3132 asthmatics who received one of three therapies: 180 ug of albuterol alone, the albuterol plus 160 ug of the steroid budesonide, or the albuterol plus a 80 ug half-dose of the budesonide.  The measure of effective rescue therapy was avoiding any inpatient admission, any ER or urgent care visit, or 3 days of systemic steroid therapy    In contrast to the 26% outcome advantage afforded by the full dose of steroid plus albuterol, the half dose yielded only a 16% advantage over albuterol alone in terms of eliminating the need for inpatient or outpatient emergency care.  Following the patients over time, the two drug therapy also reduced the annualized rate of severe exacerbation by 26% and