Single Budesonide-Formoterol vs Two-Inhalers for Asthma Rescue

Written by Hannah Harp

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The use of combined budesonide-formoterol rescue therapy in mild pediatric asthma was more cost-effective than using a budesonide-albuterol combination.

Now that’s SMART
Following major revisions to clinical guidelines for asthma in 2019, ICS-formoterol combination inhalers have been recommended for both symptomatic relief and control of asthma symptoms in children 12 years and older. This study evaluated the cost-utility of as-needed inhaled corticosteroid (ICS)-formoterol in a single inhaler compared to ICS-albuterol in separate inhalers as reliever therapy for mild pediatric asthma in Colombia. Using a Markov simulation model over 12 months, ICS-formoterol demonstrated lower costs (US$475.51 vs. $735.33 per patient) and a greater quality-adjusted life-year (QALY) gain (0.9367 vs. 0.9352 per patient), making it the dominant strategy. Findings support ICS-formoterol as a cost-effective reliever therapy in children aged 12 years or older​. This analysis was performed in Colombia, so the cost and available formulations of inhalers may differ in other countries. Also, adherence to the budesonide-albuterol pathway may have been lessened, because these medications were administered using two separate inhalers instead of a combined formulation, though this is another benefit of using the single inhaler regimen.

How will this change my practice? 
I must admit that I haven’t gotten used to starting with single maintenance and reliever therapy (SMART) combination therapy for mild-intermittent asthma. Since it is more effective and not much more expensive (Per GoodRx, ~$200/month for budesonide-formoterol HFA vs. ~$160 for separate budesonide and albuterol inhalers in the U.S.), I really need to make this change.

Source
As-Needed Inhaled Corticosteroid-Formoterol in a Single Inhaler Compared to Inhaled Corticosteroid-Albuterol in Separate Inhalers as Reliever Therapy in Mild Pediatric Asthma: A Cost-Utility Analysis. Pediatr Pulmonol. 2025 Jan;60(1):e27466. doi: 10.1002/ppul.27466. Epub 2024 Dec 31. PMID: 39739342