Combination Inhalers Outperform SABA-Only Treatment for Asthma, Study Finds

A recent study published in JAMA highlights the effectiveness of combination inhaler treatments over short-acting beta agonists (SABAs) alone in managing asthma symptoms and reducing severe exacerbations. Presented at the 2024 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Boston, the findings stem from an extensive meta-analysis of asthma therapies and underscore the superiority of combination therapies involving inhaled corticosteroids (ICS) over SABA-only inhalers.

Network Meta-Analysis Highlights ICS-SABA and ICS-Formoterol Superiority

The study conducted a systematic review and network meta-analysis of 27 randomized clinical trials, analyzing data from 50,496 children and adults with asthma. Researchers compared three types of inhaled asthma relievers: SABA-only relievers (such as albuterol), ICS-SABA combination relievers, and ICS-formoterol combination relievers. The analysis revealed that both ICS-SABA and ICS-formoterol relievers significantly reduced severe asthma exacerbations and provided better control of asthma symptoms compared to SABA-only relievers. Moreover, ICS-formoterol had an additional advantage over ICS-SABA in further reducing severe exacerbations.

One of the study’s key insights was that the absolute benefit of anti-inflammatory combination inhalers varied with the patient’s baseline risk of severe exacerbations. While patients at higher risk for exacerbations experienced more substantial benefits from ICS-SABA and ICS-formoterol relievers, those with lower risk also saw improvements, though to a lesser degree. This finding reinforces the advantage of ICS-based treatments, which address underlying inflammation—a critical driver of asthma symptoms and progression.

Implications for Clinical Practice and Guidelines

These results are expected to impact future asthma treatment guidelines, with recommendations likely shifting toward combination reliever inhalers for improved symptom control and prevention of exacerbations. As asthma care strategies evolve, the emphasis on anti-inflammatory agents represents a shift from symptom-only relief to comprehensive inflammation management.

The study’s findings could influence upcoming guidelines from the Joint Task Force on Practice Parameters, a collaboration between the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology. This trend toward anti-inflammatory treatment aligns with growing evidence that effective asthma management must go beyond acute symptom relief to address underlying inflammation.