Comparative study of inhaled steroids versus inhaled steroids plus long acting beta agonists in childhood asthma: a randomized controlled study

Wasim A. Wani, Sheeraz A. Dar, Mudasir Nazir, Ikhlas Ahmad


Background: Asthma is a chronic inflammatory condition of lung airways resulting in episodic airflow obstruction causing considerable morbidity in paediatric population. The main objective of the study was to find out whether addition of long acting beta agonists to steroids provides better asthma control.

Methods: This randomized controlled trial study was performed in children aged 6-15 years of age, with clinically stable and moderate persistent asthma.

Results: The findings of this study indicate SABA use in Budesonide/formoterol group patients was significantly less compared to budesonide group patients (1.5±1.1 v/s 2.13±0.9, p-value 0.01). Both groups experienced decrease in night time symptoms and acute exacerbations however there was no significant difference between the two groups in these variables.

Conclusions: This study showed addition of LABA to inhaled steroids in moderate persistent asthma provided better asthma control and LABA is mainly recommended to be used as add-on therapy for patients whose asthma is not controlled on low to high doses of inhaled corticosteroids.


Asthma, Budesonide, Inhaled steroids, LABA, SABA

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Andrew H. Liu, Ronina A.Cover, Joseph D. Spahn, and Donald Y.M. Leung. Childhood asthma. Nelson 19th ed. (1): 780-801.

National Heart, Lung, and Blood Institute, World Health Organization. Global Initiative for Asthma. National Institute of Health pub. 1995:95-3659.

National AE, Prevention P. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Aller Clini Immunol. 2007 Nov;120(5 Suppl):S94-138.

National Heart, Lung, Blood Institute. National Asthma Education Program. Expert Panel on the Management of Asthma. Guidelines for the diagnosis and management of asthma. National Asthma Education Program, Office of Prevention, Education, and Control, National Heart, Lung, and Blood Institute, National Institutes of Health; 1991.

Masoli M, Fabian D, Holt S, Beasley R, Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004 May;59(5):469-78.

Booth H, Richmond I, Ward C, Gardiner PV, Harkawat R, Walters EH. Effect of high dose inhaled fluticasone propionate on airway inflammation in asthma. Am J Resp Crit Care Medi. 1995 Jul;152(1):45-52.

Busse WW. What role for inhaled steroids in chronic asthma?. Chest. 1993 Nov 1;104(5):1565-71.

Duddridge M, Ward C, Hendrick DJ, Walters EH. Changes in bronchoalveolar lavage inflammatory cells in asthmatic patients treated with high dose inhaled beclomethasone dipropionate. Eur Resp J. 1993 Apr 1;6(4):489-97.

Juniper EF, Kline PA, Vanzieleghem MA, Ramsdale EH, O'byrne PM, Hargreave FE. Effect of long-term treatment with an inhaled corticosteroid (budesonide) on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. Am Rev Respir Dis. 1990 Oct 1;142(4):832-6.

Barnes PJ, Pederson S. Efficacy and safety of inhaled corticosteroids in asthma. Report of a workshop held in Eze, France, October 1992. Am Rev Respir Dis. 1993;148(4 Pt 2):S1-S26.

Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000;343(5):332-6.

Scott L, Nichols B, Choi Kwong KY, Morphew T, Jones CA. Longitudinal patterns of predominant asthma disease activity in pediatric patients enrolled in an asthma-specific disease management program. J Asthma. 2008;45(6):501-5.

Van Noord JA, Smeets JJ, Raaijmakers JA, Bommer AM, Maesen FP. Salmeterol versus formoterol in patients with moderately severe asthma: onset and duration of action. Eur Respir J. 1996;9(8):1684-8.

Palmqvist M, Persson G, Lazer L, Rosenborg J, Larsson P, Lötvall J. Inhaled dry-powder formoterol and salmeterol in asthmatic patients: onset of action, duration of effect and potency. Eur Respir J. 1997;10(11):2484-9.

Ringdal N, Derom E, Wåhlin-Boll E, Pauwels R. Onset and duration of action of single doses of formoterol inhaled via Turbuhaler®. Respir Med. 1998;92(8):1017-21.

Seberová E, Andersson A. Oxis® (formoterol given by Turbuhaler®) showed as rapid an onset of action as salbutamol given by a pMDI. Respir Med. 2000;94(6):607-11.

Zetterström O1, Buhl R, Mellem H, Perpiñá M, Hedman J, O'Neill S, et al. Improved asthma control with budesonide/formoterol in a single inhaler, compared with budesonide alone. Eur Respir J. 2001 Aug;18(2):262-8.

Bateman ED1, Bantje TA, João Gomes M, Toumbis MG, Huber RM, Naya I, et al. Combination therapy with single inhaler budesonide/formoterol compared with high dose of fluticasone propionate alone in patients with moderate persistent asthma. Am J Respir Med. 2003;2(3):275-81.

Pauwels RA1, Löfdahl CG, Postma DS, Tattersfield AE, O'Byrne P, Barnes PJ, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. N Engl J Med. 1997 Nov 13;337(20):1405-11.