3. Duplicative Therapy

The use of two or more metered-dose inhaler short-acting beta₂-adrenergic compounds concurrently for prevention and control of asthma symptoms is not justified and will be reviewed. Nebulized short-acting beta₂-adrenergic therapy is available for pediatric patients who are too ill or too young to obtain medication from an aerosolized metered-dose device.  However, adjunctive administration of a short-acting beta₂-adrenergic agonist metered-dose inhaler with a short-acting beta₂-agonist nebulized bronchodilator is also 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-agonist like salmeterol may be prescribed concomitantly. Patients may receive a long- and short-acting beta₂-adrenergic drug concurrently for short time periods to manage acute attacks. Patient profiles containing excessive prescriptions for a short-acting beta₂-adrenergic drug (i.e., frequent refill of short-acting beta₂-adrenergic agonist within a 30-day time period) in conjunction with long-acting beta₂-agonists will be reviewed.