Are As-Needed Inhaled Steroids Effective for Mild Asthma?

U.S. guidelines from the National Asthma Education and Prevention Program (NAEPP) — last updated in 2007 — recommend as-needed short-acting β-agonists (e.g., albuterol) for patients with mild intermittent asthma and daily inhaled corticosteroids (ICS) for those with mild persistent asthma. However, most patients in the latter category don't use their asthma controller inhalers daily. Because even patients with mild asthma can have severe exacerbations, in recent studies researchers have examined whether patients with mild asthma could benefit from as-needed use of ICS combined with a quick-onset but long-acting β-agonist (e.g., budesonide plus formoterol). Two such studies were published in 2019.

In one unblinded, randomized trial, patients …