ICS/LABA study questions recommendation of prescribing albuterol as only treatment for EIB in mild asthma

In mild asthma, exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting beta 2 agonists (SABAs) on demand.

Exercise-induced bronchospasm (EIB) (click to enlarge the image):

This 6-week, double-blind, parallel-group study from Sweden included 66 patients with asthma (older than 12 years of age) with EIB who were randomized to:

- SABA (terbutaline) on demand
- budesonide (400 μg) daily and terbutaline on demand
- combination budesonide (200 μg) and formoterol (6 μg) on demand

After 6 weeks of treatment with budesonide daily or combination budesonide and formoterol on demand, the post-exercise FEV1 decrease was smaller than in the group on terbutaline on demand. The total budesonide dose was 2.5 times lower in the combination budesonide and formoterol group than in the budesonide daily group.

The combination of budesonide and formoterol on demand improves asthma control by reducing EIB in the same order of magnitude as daily budesonide treatment despite a lower total steroid dose. Both these treatments were superior to terbutaline on demand, which did not alter the bronchial response to exercise. The results question the recommendation of prescribing SABAs as the only treatment for EIB in mild asthma.

Asthma Inhalers (click to enlarge the image).

ATS practice guideline: exercise-induced bronchoconstriction:


Combination of budesonide/formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction. Thorax 2014;69:130-136 doi:10.1136/thoraxjnl-2013-203557 (free full text)

Exercise-Induced Bronchoconstriction: The New Guidelines. Laura A. Stokowski, RN, MS, Jonathan P. Parsons, MD, MSc. Medscape Family Medicine, 2014.

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