Cochrane backs fixed-dose combination inhaler for mild asthma


By Mardi Chapman

24 May 2021

The Cochrane Airways Group has determined that use of a fixed dose inhaler containing both a steroid and beta‐agonist as required instead of short‐acting beta agonist (SABA) monotherapy as required is clinically effective in adults and adolescents with mild asthma.

In a review of the evidence it found fast-acting beta agonist/inhaled corticosteroid (FABA/ICS) reduced exacerbations requiring systemic corticosteroids (OR 0.45), asthma-related hospital admissions or unscheduled healthcare visits (OR 0.35), exposure to systemic corticosteroids and probably adverse events (OR 0.82).

Given exacerbations are responsible for the majority of morbidity, mortality and the economic costs of asthma, it said the findings support the GINA international guidelines that have previously been reported in the limbic.

Some enthusiastic adopters of GINA’s recommendations have gone as far as calling for a ban on the SABA blue puffer.

The Cochrane review identified five relevant studies which contributed to the meta-analysis. All five studies used budesonide 200 μg and formoterol 6 μg in a dry powder formulation as the combination inhaler.

“There would be value in further trials which assessed other fixed‐dose combinations including formulations with pressurised meter dose inhalers, ultra‐fine particle preparations, and other ICS such as beclomethasone or other FABAs such as salbutamol,” the review authors said.

They also noted the evidence did not extend past 52-week trials and did not include trials in children.

“Further research is needed to explore use of FABA/ICS as required in children under 12 years of age, use of other FABA/ICS preparations, and long‐term outcomes beyond 52 weeks,” they concluded.

The authors said the results were likely to be widely generalisable to primary care populations with mild asthma.

However they noted that implementation of their findings worldwide may depend on differing health economic assessments, differing healthcare infrastructures, and population‐specific factors in different settings.

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