As-Needed ICS Preferred Over Maintenance ICS Plus Terbutaline in Asthma

As-needed budesonide-formoterol is preferred by most patients with mild to moderate asthma compared with maintenance budesonide plus as-needed terbutaline, according to poststudy survey results published in the European Respiratory Journal.

A total of 306 individuals with self-reported, physician-diagnosed moderate to severe asthma who participated in the PRACTICAL study (Personalized Asthma Combination Therapy With Inhaled Corticosteroid and Fast-Onset Long-Acting Beta Agonist; ANZCTR Identifier: 12616000377437), a 52-week open-label, randomized control trial in New Zealand completed a survey regarding preferences, satisfaction, and beliefs about their assigned treatment during the study. The 2 randomized treatment groups included symptom-driven budesonide-formoterol and maintenance budesonide plus as-needed terbutaline. Participants completed the survey regarding treatment preferences at the last study visit.

A total of 90% of patients randomly assigned to as-needed budesonide-formoterol preferred this treatment regimen (95% CI, 85.2%-94.8%) compared with 10% who preferred twice-daily preventer inhaler with an as-needed reliever inhaler. Conversely, 40% of patients randomly assigned to maintenance budesonide plus as-needed terbutaline preferred this regimen (95% CI, 32.7%-48.1%).

A small proportion (21%) of patients randomly assigned to as-needed budesonide-formoterol reported they agreed or strongly agreed with the statement that they would have preferred to take a regular preventer inhaler to halt asthma symptoms, whereas 68% said they disagreed or strongly disagreed with this statement. Up to 92% of patients randomly assigned to as-needed budesonide-formoterol reported confidence with using it as a reliever by the end of the study compared with 74% of patients who reported they were confident with this approach at the beginning of the study.

Study limitations included the somewhat low response rate of the survey, as well as the lack of assessment of patients’ treatment preferences at the start of the trial.

According to the researchers, these findings suggest that treating a patient with mild asthma could include the option of a trial of as-needed inhaled corticosteroid formoterol.

Reference

Baggott C, Reddel HK, Hardy J, et al; on behalf of the PRACTICAL study team. Patient preferences for symptom-driven or regular preventer treatment in mild to moderate asthma – findings from the PRACTICAL study, a randomized clinical trial [published online February 6, 2020]. Eur Respir J. doi:10.1183/13993003.02073-2019