Recent clinical trials of as-needed fixed-dose combination of ICS/formoterol have provided new evidence that may warrant a reconsideration of current practice.

A task force (TF) was set up by the European Respiratory Society to provide evidence-based recommendations on the use of as-needed ICS/formoterol as treatment for mild asthma. The TF defined two questions that were assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. The TF utilised the outcomes to develop recommendations for a pragmatic guideline for everyday clinical practice.

The TF suggests that adults with mild asthma use as-needed ICS/formoterol instead of regular ICS maintenance treatment plus as-needed short-acting beta-2-antagonists (SABAs), and that adolescents with mild asthma use either as-needed ICS/formoterol or ICS maintenance treatment plus as-needed SABA (Conditional Recommendation; Low Certainty of Evidence). The recommendation for adults places a relatively higher value on the reduction of systemic corticosteroid use and the outcomes related to exacerbations and a relatively lower value on the small differences in asthma control. Either treatment options are suggested for adolescent patients as the balance is very close and data more limited.

The TF recommends that adult and adolescent patients with mild asthma use as-needed ICS/formoterol instead of as-needed SABA (Strong Recommendation; Low Certainty of Evidence). This recommendation is based on the benefit of as-needed ICS/formoterol in mild asthma on several outcomes and the risks related to as-needed SABA in the absence of anti-inflammatory treatment.

The implementation of this recommendation is hampered in countries (including European Union countries) where as-needed ICS/formoterol is not approved for mild asthma.