Expert: Marc Rubin, RPh Asthma Educator - 8/10/2008

Question
Hello Marc - you helped me before when I had a problem, which I was very
grateful for. I now have another question - I have been using Symbicort for
my asthma with a rescue inhalter of ipratropiumbromid. But a new doctor
gave me a vaporizing inhaler of salbutamol as a rescue inhalter. I recently
read that the two - salbutamol and symbicort - should not be taken together
because they are both beta2 antagonists (or something like that). I can't get
ahold of the doctor, he is difficult to reach. Is this true? If so, wouldn't it be
better to take the symbicort plus something like seretide or albuterol? Thanks
for your help, I really appreciate it.

Answer
Hi Cheryl,

There is no problem with using Salbutamol (which is the international name for albuterol) for rescue. The onset is faster than ipratropium, and has fewer side effects. Ipratropium is generally used in combination with albuterol in the emergency room setting, and also in patients with COPD. The exception to this is in patients with a genetic variation that results in very poor response to albuterol. This is more commonly seen in patients of African descent (up to 30% of those with asthma), as well as hispanic descent. This is much less frequently seen in Caucasians.

If you have had excellent results with ipratropium, I would discuss this with the doctor. Ask him if he is familiar with the Arginine-16 Beta 2 adrenoceptor genotype atudies. If the receptor is glycine-glycine, the response to albuterol is normal. If the receptor is glycine-arginine, the bronchodilation may be somewhat muted, and if the receptor if arginine-arginine (homozygous), the patient fails to respond to albuterol (salbutamol).

Note: You can be tested to determine this issue. (I normally would not get into this much detail, but since you are well-educated, I feel you would have little trouble communicating this, even though it is not in your natural field)


Good to hear from you again.

Marc