Comparative Study of Inhaled Corticosteroid/LABA Combinations on Exacerbation Rates in Moderate Asthma

Abstract

Background: Combination therapy with inhaled corticosteroids (ICS) and long-acting beta₂-agonists (LABA) remains the cornerstone for managing moderate asthma. Differences in pharmacodynamic profiles between combinations may influence exacerbation frequency and clinical control. This study aimed to compare the efficacy and safety of two commonly used ICS/LABA combinations-budesonide/formoterol and fluticasone/salmeterol-on exacerbation rates and clinical outcomes in moderate asthma.

Methods: A prospective, comparative, observational study was conducted among 160 patients with moderate persistent asthma attending a tertiary care hospital. Patients were divided equally into two groups: Group A (budesonide/formoterol, n=80) and Group B (fluticasone/salmeterol, n=80). Data on exacerbations, lung function (FEV₁, PEFR), symptom control (ACQ-5), adherence, and adverse effects were collected over six months. Statistical analysis included Student’s t-test, chi-square test, and Poisson regression; a p-value <0.05 was considered significant.

Results: The mean number of exacerbations per patient was significantly lower in Group A (0.46 ± 0.71) compared to Group B (0.73 ± 0.88; p = 0.040). The proportion of patients experiencing ≥1 exacerbation was 28.8% in Group A versus 45.0% in Group B (p = 0.033). Improvement in FEV₁ was greater in Group A (+9.3 ± 6.1 vs +6.8 ± 6.4; p = 0.012), and ACQ-5 scores decreased more substantially (-0.69 ± 0.44 vs -0.51 ± 0.46; p = 0.012). Adverse effects such as oral candidiasis and dysphonia were mild and comparable. Adherence ≥80% was achieved by 83.8% in Group A and 73.8% in Group B (p = 0.122).

Conclusion: Budesonide/formoterol demonstrated superior efficacy in reducing exacerbation rates and improving symptom control compared to fluticasone/salmeterol in moderate asthma, with comparable safety and better adherence. This combination may therefore represent an optimal maintenance option for moderate asthma patients requiring enhanced disease control.