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

Twenty‐five years of Respirology: Advances in asthma

“…As a result, there is now evidence that ICS‐formoterol reliever therapy is superior in exacerbation risk reduction compared with SABA reliever therapy across the spectrum of asthma severity, regardless of baseline maintenance therapy. The demonstration that budesonide‐formoterol reliever therapy reduces FeNO, a biomarker of airways inflammation, provides support for referring to this therapeutic approach as anti‐inflammatory reliever therapy …”

“…One of the key recommendations of the Lancet Asthma Commission was the replacement of as‐required short‐acting beta 2 ‐agonists (SABA) with combination ICS and fast‐acting beta 2 ‐agonists as reliever therapy in patients with episodic symptoms, with no escalation of ICS dose unless biomarkers of eosinophilic disease and ICS responsiveness are present . In support of this approach, two real‐world studies from the Asia‐Pacific region have shown that sole budesonide‐formoterol reliever therapy reduces the severe exacerbation risk compared with sole SABA reliever therapy, and also when compared with maintenance budesonide plus SABA reliever therapy in adults with mild or moderate asthma . These findings challenge not only the appropriateness of SABA‐only treatment, but also the necessity of regular daily ICS treatment in mild asthma.…”

“…2 In support of this approach, two real-world studies from the Asia-Pacific region have shown that sole budesonide-formoterol reliever therapy reduces the severe exacerbation risk compared with sole SABA reliever therapy, and also when compared with maintenance budesonide plus SABA reliever therapy in adults with mild or moderate asthma. 8,9 These findings challenge not only the appropriateness of SABA-only treatment, but also the necessity of regular daily ICS treatment in mild asthma.…”

The history and future of short‐acting beta2‐agonist therapy in asthma

“…The Novel START trial, conducted in mild asthmatic patients receiving SABA monotherapy, demonstrated that as required budesonide‐formoterol was superior to as required salbutamol (and also superior to regular budesonide maintenance with lower ICS exposure), in terms of reducing severe asthma exacerbations . The recently published PRACTICAL study demonstrated that as required budesonide‐formoterol resulted in a one‐third reduction in severe exacerbation risk compared with regular budesonide and as required SABA therapy in patients with mild to moderate asthma, despite the budesonide‐formoterol group using about 60% of the dose of budesonide . Budesonide‐formoterol reliever therapy reduces the FeNO, a marker of eosinophilic airway inflammation, thereby suggesting that this therapeutic regimen could be ideally referred to as ‘anti‐inflammatory reliever therapy’ in clinical practice.…”

“…14 The recently published PRACTICAL study demonstrated that as required budesonide-formoterol resulted in a one-third reduction in severe exacerbation risk compared with regular budesonide and as required SABA therapy in patients with mild to moderate asthma, despite the budesonideformoterol group using about 60% of the dose of budesonide. 15 Budesonide-formoterol reliever therapy reduces the FeNO, a marker of eosinophilic airway inflammation, 14 thereby suggesting that this therapeutic regimen could be ideally referred to as 'anti-inflammatory reliever therapy' in clinical practice. These trials did not include children younger than 12 years and, therefore, the safety and efficacy of as required budesonideformoterol in a paediatric population is unknown.…”