Once again, maintenance and reliever use of inhaled corticosteroids/formoterol (eformoterol) for asthma was superior to using salbutamol as a rescue inhaler.

Both the National Asthma Education and Prevention Program (JAMA 2020; 324: 2301-2317) and the Global Initiative for Asthma (GINA) guidelines recommend using single maintenance and reliever therapy (MART) for all patients with moderate-to-severe asthma. GINA goes a step further and states that salbutamol should no longer be used and that inhaled corticosteroids (ICS) with formoterol (eformoterol) in a single inhaler should be the reliever of choice. Although we have excellent randomised trials supporting use of MART, we have few ‘real-world’ studies.

In a retrospective study from South Korea, researchers compared two groups: the MART group (231 adults) received ICS/formoterol twice daily for maintenance and used the same inhaler as needed for relief; in contrast, the non- MART group (512 adults) received ICS/long-acting beta-agonist (LABA) as maintenance therapy but used short-acting salbutamol for as-needed therapy. After a median 120 days, severe asthma exacerbations were significantly less frequent in the MART group (hazard ratio, 0.39), and systemic corticosteroid use was significantly lower in the MART group.

Comment: Despite overwhelming evidence and recommendations from both US and international guidelines, uptake of MART dosing has been slow in my community. I have tried to minimise prescribing salbutamol and to use MART whenever patients’ insurance allows. I typically use budesonide/formoterol (80/4.5mcg or 160/4.5mcg) at one puff twice daily plus one puff whenever needed (12 or fewer puffs daily in adults). Most patients are limited to 120 puffs (one canister) monthly under insurance coverage, but the majority of patients achieve control with less than one canister monthly.
DAVID J. AMROL, MD
Associate Professor of Clinical Internal Medicine, Director of the Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, USA.

Kim C, et al. Effectiveness of maintenance and reliever therapy using inhaled corticosteroid-formoterol in asthmatics. J Allergy Clin Immunol Pract 2022; 10: 2638-2645.

This summary is taken from the following Journal Watch title: General Medicine.