3. Duplicative Therapy

Adjunctive administration of multiple short-acting or long-acting, nebulized beta2-adrenergic bronchodilators does not provide additional clinical benefit and may result in additive adverse effects^1-8. Combined administration of multiple nebulized short-acting or long-acting beta2-adrenergic bronchodilators is not recommended and will be reviewed.

Acute asthma exacerbations require treatment with short-acting, beta2-adrenergic agents even though maintenance therapy with a long-acting, beta2-adrenergic agent may be prescribed concomitantly^1-8. Patients may receive a long- and short-acting beta2-adrenergic drug concurrently for short time periods to manage acute attacks. Nebulized formoterol or arformoterol used in conjunction with excessive administration of a short-acting beta2-adrenergic drug (i.e., frequent refill of short-acting beta2-adrenergic agonist within a 30-day time period) is not recommended and will be reviewed.

Concurrent administration of ipratropium nebulized solution monotherapy with ipratropium/racemic albuterol combination therapy does not provide additional clinical benefit and may result in additive adverse effects^1,2,14. Combined administration of ipratropium and ipratropium combination therapy is not recommended and will be reviewed.