Pneumology - Original Articles
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https://doi.org/10.4081/monaldi.2025.3355

Role of inhaled corticosteroids/formoterol in relieving acute asthma as compared to traditional salbutamol in children 6 to 11 years old on maintenance and reliever therapy step 3 and above as per the Global Initiative for Asthma guideline

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Received: 15 January 2025
Accepted: 30 April 2025
Published: 11 June 2025
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Acute asthma exacerbation, reliever, inhaled corticosteroids, formoterol, short acting β-agonists

Authors

Danish Abdul Aziz
drdanishaziz@gmail.com
Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
Werdah Viquar
Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.

The recent Global Initiative for Asthma (GINA) guidelines offer two reliever therapy options for patients on step 3 and above: the more popularly used short-acting β-agonists (SABA) and the newly introduced inhaled corticosteroids (ICS)-formoterol combination. Our aim was to assess the effectiveness of the ICS/formoterol combination in comparison to the traditional SABA offered to patients aged 6-11 years old following step 3 and above of the GINA guidelines. A retrospective study was conducted at a tertiary care facility in Karachi, Pakistan. The study involved children aged 6-11 years old who were admitted with an asthma exacerbation and were subsequently discharged on step 3 and above as per the GINA guidelines for 3 months. The patients were then categorized into two groups depending on the type of reliever used (ICS/formoterol or salbutamol). There were 80 pediatric patients enrolled in our study. The emergency room visits with asthma exacerbation in 3 months following discharge were significantly lower in the ICS/formoterol reliever group (1.27±0.83) than in the salbutamol reliever group (1.93±1.36) (p=0.01). Mean admission with asthma in 6 months post-discharge was significantly higher in the salbutamol group (2.18±0.82) as compared to the ICS/formoterol group (1.24±0.83). Moreover, the number of patients requiring step-up control within 3 months of discharge was also significantly lower in the ICS/formoterol group, with 2 patients, than the salbutamol group, with 10 patients (p=0.02). The forced expiratory volume in 1 second value 3 months after discharge was significantly greater in the ICS/formoterol group (91.27±8.32) than in the salbutamol group (84.58±10.44) (p=0.02). Through our analysis, we were able to highlight the superiority of ICS/formoterol as a reliever compared to SABA for moderate asthma.

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Crossref
Scopus
Google Scholar
Europe PMC
Castillo JR, Peters SP, Busse WW. Asthma exacerbations: pathogenesis, prevention, and treatment. J Allergy Clin Immunol Pract 2017;5:918-27. DOI: https://doi.org/10.1016/j.jaip.2017.05.001
Reddel HK, Bacharier LB, Bateman EDet al. Global Initiative for Asthma (GINA) Strategy 2021 – executive summary and rationale for key changes. Am J Respir Crit Care Med 2021;205:17-35. DOI: https://doi.org/10.1164/rccm.202109-2205PP
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023. Available from: https://ginasthma.org/2023-gina-main-report/.
Kaplan A, Mitchell PD, Cave AJ, et al. Effective asthma management: is it time to let the AIR out of SABA? J Clin Med 2020;9:921. DOI: https://doi.org/10.3390/jcm9040921
Balanag VM, Yunus F, Yang PC, Jorup C. Efficacy and safety of budesonide/formoterol compared with salbutamol in the treatment of acute asthma. Pulm Pharmacol Ther 2006;19:139-47. DOI: https://doi.org/10.1016/j.pupt.2005.04.009
BMJ Best Practice. Acute asthma exacerbation in adults. Available from: https://bestpractice.bmj.com/topics/en-gb/3000085#:~:text=Definition
Fuhlbrigge A, Peden D, Apter AJ, et al. Asthma outcomes: exacerbations. J Allergy Clin Immunol 2012;129:S34-48. DOI: https://doi.org/10.1016/j.jaci.2011.12.983
Wang Z, Li Y, Gao Y, et al. Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Respir Res 2023;24:169. DOI: https://doi.org/10.1186/s12931-023-02475-6
Ozseker ZF, Aksu K, Mutlu LC, et al. Expert opinion on practice patterns in mild asthma after the GINA 2019 updates: a major shift in treatment paradigms from a long-standing SABA-only approach to a risk reduction–based strategy with the use of symptom-driven (as-needed) low-dose ICS/LABA. Curr Allergy Asthma Rep 2022;22:123-34. DOI: https://doi.org/10.1007/s11882-022-01038-x
Sriprasart T, Waterer G, Garcia G, et al. Safety of SABA monotherapy in asthma management: a systematic review and meta-analysis. Adv Ther 2022;40:133-58. DOI: https://doi.org/10.1007/s12325-022-02356-2
Bruce P, Hatter L, Houghton C, et al. The anti-inflammatory reliever (AIR) algorithm study: a protocol for a single-group study of an AIR stepwise approach to the treatment of adult asthma. ERJ Open Res 2023;9:00239-2023. DOI: https://doi.org/10.1183/23120541.00239-2023
Krings JG, Beasley R. The role of ICS-containing rescue therapy versus SABA alone in asthma management today. J Allergy Clin Immunol Pract 2024;12:870-9. DOI: https://doi.org/10.1016/j.jaip.2024.01.011
Bruce P, Hatter L, Beasley R. Anti‐inflammatory reliever therapy in asthma: the evidence mounts but more is needed. Respirology 2020;25:776-8. DOI: https://doi.org/10.1111/resp.13889
Beasley R, Braithwaite I, Semprini A, et al. ICS-formoterol reliever therapy stepwise treatment algorithm for adult asthma. Eur Respir J 2020;55:1901407. DOI: https://doi.org/10.1183/13993003.01407-2019
Lazarinis N, Jørgensen L, Ekström T, et al. Combination of budesonide/formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction. Thorax 2013;69:130-6. DOI: https://doi.org/10.1136/thoraxjnl-2013-203557
Pauwels RA, Sears MR, Campbell M, et al. Formoterol as relief medication in asthma: a worldwide safety and effectiveness trial. Eur Respir J 2003;22:787-94. DOI: https://doi.org/10.1183/09031936.03.00055803
Tattersfield AE, Löfdahl CG, Postma DS, et al. Comparison of formoterol and terbutaline for as-needed treatment of asthma: a randomised trial. Lancet 2001;357:257-61. DOI: https://doi.org/10.1016/S0140-6736(00)03611-4
Beasley R, Harper J, Bird G, et al. Dose-response relationship of ICS/fast-onset LABA as reliever therapy in asthma. BMC Pulm Med 2019;19:264. DOI: https://doi.org/10.1186/s12890-019-1014-4
O’Byrne PM, Bisgaard H, Godard PP, et al. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med 2005;171:129-36. DOI: https://doi.org/10.1164/rccm.200407-884OC
Kuna P, Peters MJ, Manjra AI, et al. Effect of budesonide/formoterol maintenance and reliever therapy on asthma exacerbations. Int J Clin Pract 2007;61:725-36. DOI: https://doi.org/10.1111/j.1742-1241.2007.01338.x

Ethics Approval

Approval was received by the Ethics Review Committee (2024-10088-29895) at Aga Khan University Hospital.

How to Cite



“Role of Inhaled Corticosteroids Formoterol in Relieving Acute Asthma As Compared to Traditional Salbutamol in Children 6 to 11 Years Old on Maintenance and Reliever Therapy Step 3 and above As Per the Global Initiative for Asthma Guideline”. 2025. Monaldi Archives for Chest Disease, June. https://doi.org/10.4081/monaldi.2025.3355.
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