Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52-week, open-label, multicentre, superiority, randomised controlled trial

In this study (n=885) it was shown that over 52 weeks patients randomized to receive budesonide–formoterol as needed had fewer severe exacerbations than those randomised to maintenance low-dose budesonide plus as-needed terbutaline (0·119 vs 0·172, p= 0.049).

The authors conclude that these results support 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. However in the associated editorial the authors raise questions about extrapolation to patients without type 2 inflammation as evidenced by increased eosinophils. They also raise concerns over how clinicians determine if the asthma is “mild” enough for as-needed inhaled corticosteroid-β-agonist therapy given the lack of biomarkers available in mild asthma. Finally they raise the question of when should as-needed combination therapy be stopped.

However overall they conclude that, “Many studies now support as-needed inhaled corticosteroid-β-agonist therapy as an effective treatment for patients with mild asthma and even some with moderate asthma” and that “this combination could modestly improve asthma outcomes over daily maintenance therapy, reduce overall inhaled corticosteroid burden, and possibly improve patient satisfaction”.