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Can asthma attacks in children be reduced by almost half? Lancet study finds combination inhaler safe

This landmark study shows how asthma burden can be reduced in countries like India, says expert

4 min readOct 6, 2025 04:37 PM IST

According to Prof David Jackson, respiratory medicine expert at King’s College London and lead author of the study, the treatment significantly improved asthma symptoms, lung function and overall quality of life. (File Photo)

Having an asthma attack can be scary for both children and their parents. Reducing the frequency of these bouts and their severity is a public health priority, say researchers of a new trial, published in The Lancet. Which is why a combination inhaler, which the researchers found can reduce such attacks in children by almost half, could redefine how children with asthma are treated.

In the first randomised controlled trial to investigate the use of a two-in-one inhaler as the sole reliever therapy for children aged between five and 15, an international team found the combined treatment (budesonide-formoterol) to be more effective than salbutamol, the current standard for asthma symptom relief in children, with no additional safety concerns.

What are combined and single inhalers?

The combined formulation is budesonide-formoterol. A budesonide is a corticosteroid that reduces inflammation and swelling in the airways. Formoterol relaxes and widens the muscles in the airways. Salbutamol is a medication used for quick relief.

Dr Sundeep Salvi, pulmonologist and member of Global Initiative for Asthma (GINA) told The Indian Express that this study has shown that treating asthmatic children between the ages of five and 15 with a combination of inhaled salbutamol and a steroid prevented the exacerbation of asthma by 45 per cent. “This landmark study will now help offer better treatments to asthmatic children,” he says.

On the CARE study

The CARE study (Children’s Anti-inflammatory REliever) was designed and led by the Medical Research Institute of New Zealand (MRINZ) in collaboration with Imperial College London, University of Otago Wellington, Starship Children’s Hospital, and the University of Auckland. It recruited 360 children across New Zealand who were then randomly assigned to receive either budesonide-formoterol or salbutamol for on-demand symptom relief.

Over a year, the budesonide-formoterol reliever resulted in a lower rate of asthma attacks than salbutamol reliever, with rates of 0.23 versus 0.41 per participant per year. This means that for every 100 children with mild asthma who are switched from salbutamol to a 2-in-1 budesonide-formoterol inhaler, there would be 18 fewer asthma attacks per year.

How safe is the combined inhaler?

Importantly, the study also confirmed the safety of the combined-inhaler approach, with no significant differences in children’s growth, lung function or asthma control between the two groups.

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While the 2-in-1 budesonide-formoterol inhaler is widely recommended as the preferred reliever treatment for adults, children are still usually prescribed salbutamol. Dr Lee Hatter, lead author of the study and Senior Clinical Research Fellow at the MRINZ, said that this is a key step in addressing the evidence gap that exists between asthma management in adults and children. “For the first time, we have demonstrated that the budesonide-formoterol 2-in-1 inhaler, used as needed for symptom relief, can significantly reduce asthma attacks in children with mild asthma. This evidence- based treatment could lead to improved asthma outcomes for children worldwide,” Dr Hatter added

What do the findings mean for India?

India contributes to 43 per cent of global asthma deaths, one of the major reasons being the low use of inhaled steroids. “The overuse of salbutamol without a steroid is rampant in our country and is causing more harm to children. Parents are reluctant to give steroids to their asthmatic child because of fear of side effects. However this fear is not warranted, because the benefit it offers far outweighs the side effects – which are few if the right dose is taken as prescribed by the doctor,” Dr Salvi says. “The GINA and Lancet Asthma Commissions too had earlier recommended replacing salbutamol inhalers with a combination of a drug containing a steroid for adolescents and adults with asthma. This new study has suggested to do the same in children with asthma between five and 15 years,” he explains.

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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