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Anti-inflammatory inhalers reduce the risk of serious asthma complications
Last reviewed: 02.07.2025
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Recent studies have shown that anti-inflammatory inhalers not only reduce the risk of serious asthma complications, but also provide modest improvements in symptom control compared with traditional bronchodilators.
In a recent study published in JAMA, a team of researchers evaluated and compared the effectiveness of short-acting beta-agonists (SABAs) alone and in combination with inhaled corticosteroids (ICS), as well as formoterol combined with ICS, in managing asthma symptoms and reducing complications.
Asthma affects approximately 262 million people worldwide and is characterized by inflammation of the airways and variable airflow obstruction. Reliever inhalers, including SABAs such as albuterol and ICS in combination with SABAs or formoterol, are used to relieve symptoms such as shortness of breath, wheezing, and cough.
Although guidelines suggest the use of ICS-formoterol as a preferred reliever over SABA alone, the recent FDA approval of SABA has created confusion regarding the optimal choice of inhaler. Further research is needed to clarify the comparative benefits of ICS-SABA and ICS-formoterol for clinical outcomes in asthma management.
This systematic review, registered in PROSPERO, complies with the PRISMA guidelines. A systematic search of MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed from 1 January 2020 to 27 September 2024, focusing on published and unpublished randomised clinical trials (RCTs) evaluating inhaled therapeutic agents for asthma.
The review included various inhaled relievers such as SABA and combinations of ICS with SABA or formoterol. Reviewers independently assessed titles, abstracts and full texts using standardised data extraction forms. Outcomes considered included asthma symptom control, quality of life, serious complications and adverse events.
The systematic search identified 3,179 unique citations and 201 potentially relevant full articles. Ultimately, 26 articles describing 27 unique RCTs involving 50,496 patients were included in the review. The mean age of participants in these trials was 41.0 years, with men accounting for an average of 41% of participants.
Treatment duration varied, averaging 26 weeks. All RCTs investigating rapid-acting, long-acting β-agonists assessed formoterol, and two trials focused on patients under 18 years of age.
Among 138 risk of bias assessments for study results, 113 (82%) indicated a low overall risk of bias. Visual inspections of funnel plots and assessments of potential effect modifiers revealed no significant evidence of small study effects or network inconsistency.
The study found that anti-inflammatory inhalers with ICS-formoterol and ICS-SABA significantly reduced the risk of serious complications and offered modest improvements in asthma symptom control compared with a bronchodilator inhaler. Both anti-inflammatory methods showed no statistically significant difference in the risk of adverse events.
Although ICS-formoterol is likely to be associated with a lower risk of serious complications compared with ICS-SABA, it may not result in significant improvements in asthma symptoms or quality of life. This review used a comprehensive search strategy and included trials not covered by previous reviews.