Written by Kimi Dunbar
Spoon Feed
According to a large number of RCTs, both pediatric and adult patients seem to have better asthma control with combined asthma therapy: inhaled corticosteroid (ICS) and short-acting β-agonists (SABA) or long-acting β-agonists (LABA) as opposed to a SABA alone.
Synopsis
This systematic review and meta-analysis compared three inhaled reliever therapies for asthma: SABA alone, ICS with SABA, and ICS with formoterol. Analyzing 27 randomized clinical trials with over 50,000 participants, the study found that both ICS-formoterol and ICS-SABA significantly reduced severe asthma exacerbations and improved asthma control compared to SABA alone, with ICS-formoterol demonstrating the greatest reduction in exacerbations. Both ICS-containing treatments did not increase adverse event risk relative to SABA alone. These findings support the use of ICS-formoterol as a preferred reliever option to optimize asthma management outcomes. (AI-generated)
The whole is greater than the sum of its parts
The NIH released updated asthma guidelines in 2020, long overdue following the last guideline release in 2007. These guidelines include 18 recommendations applicable to the pediatric population, one of which is the use of ICS-formoterol in children ≥4 years with moderate to severe asthma. This rescue/controller combination inhaler, also known as SMART – single maintenance and reliever therapy – is attractive because it requires just one inhaler and reduces total exposure to steroids. This study is aligned with these guidelines, reinforcing the benefits of SMART therapy. That said, the article applies these findings to all patients with asthma broadly, without differentiating between level of asthma severity. Again, the NIH guidelines only recommend ICS-formoterol for children with moderate to severe asthma who are not controlled on low-dose ICS. Participants in the 27 studies had a mean age of 41 years, so this study is most applicable to adult populations; however, 2 of the included trials included just pediatric populations. Overall, the idea of one inhaler for patients with moderate to severe symptoms is compelling. Though this won’t change my practice for children with mild asthma, it influences my management of those with moderate or severe symptoms.
Source
Inhaled Reliever Therapies for Asthma: A Systematic Review and Meta-Analysis. JAMA. 2024 Oct 28:e2422700. doi: 10.1001/jama.2024.22700. Epub ahead of print. PMID: 39465893
