Combined LABA + inhaled steroids when required for mild asthma

A year-long study in New Zealand has investigated the efficacy of combination budesonide–formoterol reliever therapy compared with maintenance budesonide plus as-needed terbutaline.. The study used an open-label randomised controlled design, and enrolled subjects aged 18–75 years with a self-reported doctor’s diagnosis of asthma and who were using a short acting beta agonist for symptom relief with or without maintenance low to moderate doses of inhaled corticosteroids in the previous 12 weeks. 890 Participants were treated with budesonide 200 μg–formoterol 6 μg Turbuhaler (one inhalation as needed for relief of symptoms) or maintenance budesonide 200 μg Turbuhaler (one inhalation twice daily) plus terbutaline 250 μg Turbuhaler (two inhalations as needed). Severe exacerbations were lower with as-needed budesonide–formoterol than with maintenance budesonide plus terbutaline as needed (absolute rate per patient per year 0·119 vs 0·172). Nasopharyngitis was the most common adverse event in both groups. The study results support the principles that now form the basis for the 2019 Global Initiative for Asthma recommendation that inhaled corticosteroid–formoterol reliever therapy is an alternative regimen to daily low-dose inhaled corticosteroid for patients with mild asthma. The study was recently published on line in the Lancet.