New research has found that one inhaler containing two drugs can cut the risk of asthma attacks by almost half, giving hope to an estimated millions of families worldwide.
This new study, termed the CARE (Children’s Anti-inflammatory REliever) trial, the first randomised controlled investigation to directly compare the effectiveness of a budesonide-formoterol 2-in-1 inhaler against traditional salbutamol, revealed that this 2-in-1 inhaler is not only safe but also works for five-year-olds and younger.
The results show that using a single 2-in-1 anti-inflammatory reliever inhaler, which combines the inhaled corticosteroid (ICS) budesonide and the fast-acting bronchodilator formoterol, reduced children’s asthma attacks by an average of 45%, compared to the widely used salbutamol inhaler.
Asthma is the most prevalent long-term childhood illness, with around 113 million young people worldwide thought to be affected. The attacks can be fatal, so preventing them is as vital as alleviating them.
For decades, salbutamol inhalers have been the cornerstone of asthma symptom relief for children aged five to fifteen, despite increasingly compelling evidence supporting alternative treatments in adults. It rapidly expands the airways but doesn’t do much to stop swelling.
The CARE study was undertaken by the Medical Research Institute of New Zealand in collaboration with Imperial College London, University of Otago, Wellington, Starship Children’s Hospital, and the University of Auckland.
Researchers followed 360 New Zealand children aged between 5 and 15 years for a year. Half of them were told to take the combined budesonide-formoterol inhaler every time they experienced symptoms. The control group utilised the standard salbutamol inhaler.
Children on the combined inhaler, on average, experienced 0.23 attacks per year, while children on salbutamol experienced 0.41 attacks. Simply put, if 100 children made the change from salbutamol to the new alternative, 18 attacks would be prevented per year.
Equally as important, no other safety problems were found in the study. Side effect rates were effectively identical in both groups, and there were no differences in lung function, growth, or overall asthma control.
Researchers say the findings, published today in The Lancet, provide the evidence needed to bring children’s global asthma guidelines into line with adults’, which could benefit millions of children around the world with mild-to-moderate asthma.
Dr. Lee Hatter, first author of the study and Senior Clinical Research Fellow at Medical Research Institute of New Zealand, called the results a breakthrough.
Hatter declared: “For the first time, we have demonstrated that the budesonide-formoterol 2-in-1 inhaler, used as needed for relief of symptoms, can markedly prevent asthma attacks in children with mild asthma. This evidence-based treatment has the potential to lead to improved asthma outcomes in children globally.”
In a remark, Dr Andrew Bush, a senior respiratory paediatrics consultant at Imperial College London and one of the researchers behind the study, said: “I am thrilled that we have been able to show that an inhaler that significantly halves attacks—a breakthrough in itself for adults—is safe for children with mild asthma too. We believe this will transform the management of asthma worldwide.”
The CARE study has the potential to alter the way asthma in children is treated across the world. By proving that a single inhaler can both treat symptoms and prevent attacks, the study supports combining pediatric with adult recommendations.
