Pediatrics
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From the Journals

Corticosteroid Combinations vs Standard Inhalers for Asthma: Which is More Effective?

Conexiant

Inhaled corticosteroid combinations, particularly inhaled corticosteroid–formoterol, could reduce severe asthma exacerbations by about 10% in absolute risk reduction compared with traditional short-acting β-agonist inhalers, according to a recent systematic review and meta-analysis.

In the study, published in JAMA, investigators evaluated the efficacy of inhaled corticosteroid (ICS) combination therapies compared with short-acting β-agonist (SABA) monotherapy for asthma management. Analyzing data from 27 randomized clinical trials with 50,496 adult and pediatric patients (mean age = 41 years, 40% male), the study assessed outcomes between SABA alone, SABA combined with ICS (ICS-SABA), and formoterol combined with ICS (ICS-formoterol).

Key findings indicated that both ICS-SABA and ICS-formoterol therapies were associated with reduced severe asthma exacerbations relative to SABA monotherapy. Specifically, ICS-formoterol was associated with a 10.3% reduction in exacerbation risk (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.60–0.72), while ICS-SABA achieved a 4.7% reduction (RR = 0.84, 95% CI = 0.73–0.95). Additionally, both combination therapies showed improvements in asthma symptom control as measured by the Asthma Control Questionnaire. ICS-formoterol improved asthma control scores by 4.1% (RR = 1.07, 95% CI = 1.04–1.10), and ICS-SABA by 5.4% (RR = 1.09, 95% CI = 1.03–1.15).

Safety outcomes indicated no statistically significant increase in serious adverse events for either ICS-formoterol (risk difference [RD] = –0.6%, 95% CI = –1.3% to 0%) or ICS-SABA (RD = 0%, 95% CI = –1.1% to 1.2%) when compared with SABA alone. An indirect analysis further suggested that ICS-formoterol may provide some additional reduction in exacerbation risk compared with ICS-SABA (RR = 0.78, RD = –5.5%); however, additional research is warranted to confirm these findings.

High-certainty evidence indicated that both ICS-formoterol and ICS-SABA were associated with reduced exacerbation risk and improved symptom control without an increase in adverse events in patients with asthma.

Full disclosures can be found in the published review.