Health
Recent research indicates that combination inhalers, which provide both immediate relief and long-term prevention, are the most effective option for minimizing asthma attacks in young children.
Combination inhalers offer optimal asthma treatment for all ages
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Combination inhalers, which provide swift symptom relief alongside a preventative measure, have already been recommended as the standard treatment for mild asthma in individuals aged 12 and older in several countries, including the UK and the US. A groundbreaking study involving nearly 400 children in New Zealand indicates that these inhalers may also significantly reduce asthma attacks in younger children, nearly cutting the frequency in half.
According to research team member Andy Bush from Imperial College London, while it remains uncertain whether national and international guidelines will evolve based on these findings, the evidence is compelling. “If it were my child with asthma, I’d ensure they were on the combination inhaler,” he states confidently.
The previous standard treatment for mild asthma typically involved inhalers containing salbutamol (or albuterol), which temporarily relax the airway muscles for 3 to 4 hours. Patients were advised to use these “reliever” inhalers as necessary. If the reliever inhalers were not enough to control symptoms, patients were prescribed a second inhaler containing a steroid, intended to combat the inflammation associated with asthma. Historically, it was believed that these āpreventerā inhalers had to be taken regularly for effective long-term management, with frequent reminders that normal dosing relied on a twice-daily regimen.
However, recent large-scale trials, including those focused on teens and adults, have shown that combination inhalers (comprising a steroid called budesonide and a long-acting beta-agonist, formoterol) are more effective than the traditional treatment protocol, even when utilized on an as-needed basis. Unlike salbutamol, formoterol has a longer duration of effect, lasting up to 12 hours.
Concerns regarding the impact of steroids in combination inhalers on children’s growth have also been alleviated, as the latest study found no adverse effects over the trial period. This research compared the treatment of 360 children, who were randomly assigned to either budesonide-formoterol or on-demand salbutamol for symptom relief, with a corresponding step up to either twice-daily budesonide-formoterol or fluticasone in cases of severe asthma exacerbation.
Moreover, previous trials highlight that the use of combination inhalers can reduce overall steroid intake. This is primarily because when utilized on-demand, the inhaled steroid doses fluctuate according to the severity of symptoms. Consequently, minimizing asthma attacks leads to a reduced necessity for many patients to transition to twice-daily combinations, or to need additional courses of oral steroid treatment.
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