In the pivotal FACET study, a lower dose of budesonide/formoterol
improved current asthma control compared with a higher
dose of budesonide alone, although the lower dose of budesonide/
formoterol was associated with a smaller reduction in the exacerbation
risk compared with a higher dose of budesonide alone [3].
Similarly, the GOAL study showed that addition of salmeterol to
fluticasone improved health status and exacerbation risk compared
with fluticasone alone, although it is not known whether this
approach is more beneficial than increasing the dose of fluticasone
monotherapy [4]. The use of ICS/LABA maintenance and reliever
therapy provides an alternative strategy to fixed-dose ICS/LABA
maintenance therapy plus SABA, reducing the frequency of exacerbations
and improving asthma control in patients with previously
poorly controlled asthma and a history of exacerbations.
While one clinical study has demonstrated that beclometasone/
formoterol maintenance and reliever therapy is more effective at
reducing asthma exacerbations than beclometasone/formoterol
plus SABA [19], there is a large body of evidence to show that
treatment with budesonide/formoterol maintenance and reliever
therapy improves both current control and future risk compared
with ICS/LABA plus SABA or a higher dose of budesonide alone