A new international study has found that a two-in-one asthma inhaler can almost halve the number of asthma attacks in children compared with the standard treatment.
The findings, published in The Lancet, could change the way doctors treat asthma in children around the world.
Asthma is one of the most common chronic illnesses in children, and attacks can be frightening and sometimes life-threatening.
Reducing their frequency has long been a top priority for doctors and public health experts.
For many years, children with asthma have been prescribed salbutamol, a fast-acting reliever inhaler that eases symptoms like wheezing and shortness of breath.
While effective at providing quick relief, salbutamol does not prevent future attacks.
Adults, however, are often treated with a newer option: a combined inhaler that contains both a reliever and an anti-inflammatory medication.
The new study, known as the CARE trial (Children’s Anti-inflammatory Reliever), is the first randomized controlled trial to test this two-in-one approach in children aged 5 to 15.
Led by the Medical Research Institute of New Zealand in collaboration with Imperial College London, the University of Otago, Starship Children’s Hospital, and the University of Auckland, the trial recruited 360 children in New Zealand.
Participants were randomly assigned to use either the traditional salbutamol inhaler or the budesonide-formoterol inhaler whenever they needed relief from symptoms.
Over the course of a year, the results were clear.
Children using the two-in-one budesonide-formoterol inhaler had 45 percent fewer asthma attacks compared with those using salbutamol. On average, the rate of asthma attacks was 0.23 per child per year in the combined inhaler group compared with 0.41 in the salbutamol group.
This means that for every 100 children switched to the combined inhaler, there would be 18 fewer asthma attacks each year. Just as importantly, the study found no safety concerns, with no differences in children’s growth, lung function, or overall asthma control between the two groups.
Dr. Lee Hatter, the study’s lead author, said this research closes a critical gap in asthma treatment. “For the first time, we have shown that the budesonide-formoterol two-in-one inhaler, used only when needed, can significantly reduce asthma attacks in children with mild asthma. This evidence-based treatment could lead to better outcomes for millions of children worldwide.”
Professor Richard Beasley, senior author and Director of the Medical Research Institute of New Zealand, emphasized the global significance. “Implementing these findings could transform asthma management on a worldwide scale,” he said. “We now have strong evidence that the two-in-one inhaler is more effective than salbutamol for preventing asthma attacks in children.”
Experts outside the study also welcomed the results. Professor Andrew Bush of Imperial College London said the findings prove that a treatment already considered a “game-changer” for adults is also safe and effective for children.
Professor Helen Reddel, Chair of the Science Committee of the Global Initiative for Asthma, noted that asthma attacks affect every aspect of children’s lives, from physical health to emotional well-being. Preventing them, she said, should be a top priority.
Globally, around 113 million children and adolescents live with asthma. The researchers believe that updating international guidelines to reflect these findings could improve care for millions of families.
While the study did take place during the COVID-19 pandemic—when reduced circulation of viruses may have lowered overall asthma attack rates—the researchers stress that the real-world design of the trial means the results are still highly relevant to everyday clinical practice.
Professor Bob Hancox, Medical Director of the New Zealand Asthma and Respiratory Foundation, summed up the potential impact: “This research shows that the two-in-one inhaler is both effective and safe for children as young as five.
It will help to reduce the burden of asthma and give children and their families the chance to breathe easier.”
