ASTHMA treatment strategies are shifting as new clinical trial data highlight the benefits of anti-inflammatory reliever approaches over traditional bronchodilator-only therapies. In a Phase IV randomized controlled trial, budesonide-formoterol reliever therapy demonstrated superior reductions in airway inflammation compared with terbutaline in adults with mild-to-moderate asthma receiving maintenance inhaled corticosteroids.
Budesonide-Formoterol Reliever Reduces Airway Inflammation
The INFORM ASTHMA trial enrolled 181 participants aged 16–75 years with a confirmed diagnosis of asthma and evidence of type 2 airway inflammation, defined by fractional exhaled nitric oxide (FeNO) ≥25 ppb. All participants were receiving maintenance inhaled corticosteroids and were randomized to either budesonide-formoterol reliever therapy or terbutaline reliever therapy for 26 weeks.
At baseline, geometric mean FeNO levels were elevated in both groups. By Week 26, FeNO decreased to 39.65 ppb in the budesonide-formoterol group compared with 52.98 ppb in the terbutaline group. This corresponded to a mean reduction of 18.50% (95% CI: 2.72–31.73; p=0.024) with budesonide-formoterol, demonstrating a statistically significant improvement in airway inflammation.
Implications for Asthma Management
These findings address a key evidence gap in patients already receiving maintenance inhaled corticosteroids, where randomized data on reliever strategies have been limited. Unlike short-acting β2-agonists, which provide bronchodilation without targeting inflammation, budesonide-formoterol delivers both rapid symptom relief and anti-inflammatory action.
The results support a shift toward combination reliever therapy in routine asthma care, particularly for patients with persistent airway inflammation despite maintenance treatment. This approach may improve disease control without increasing baseline corticosteroid exposure, aligning with evolving treatment paradigms focused on inflammation-driven management.
Comparable Safety Across Treatment Groups
Safety outcomes were similar between groups. Adverse events occurred in 83% of participants receiving budesonide-formoterol and 78% of those receiving terbutaline (relative risk: 1.06; 95% CI: 0.91–1.22; p=0.46). No deaths were reported during the study.
These findings reinforce the tolerability of budesonide-formoterol as a reliever option and support its use as a safe alternative to short-acting β2-agonists in this population.
Reference
Noble JH et al. Budesonide-formoterol versus terbutaline reliever in adults with asthma using maintenance inhaled corticosteroids. Lancet Respir Med. 2026;14(2):151-162.
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