Will the new treatment recommendations for asthma increase adverse events?

The Global Initiative for Asthma has since 2019 recommended as-needed inhaled steroids (ICS)/formoterol either alone or in combination with ICS/long-acting β2-agonists (LABA) maintenance for mild to moderate asthma. This might give patients more adverse effects by using LABA instead of short-acting β2-agonists (SABA) and by using ICS as needed where the patient might not be able to wash their mouth after use. The objective of this study is through a literature review to investigate whether the new recommendations increase the incidence of adverse events. We included 15 randomized clinical trials. They showed no increase in adverse events with as-needed ICS/formoterol only compared with either as-needed SABA only or maintenance ICS and SABA as-needed, and even a small tendency to less adverse events. When comparing as-needed and maintenance ICS/formoterol with as-needed SABA and maintenance ICS/LABA a small increase was seen for some adverse events, especially candidiasis (1.4 vs. 0.7%) and dysphonia (1.5 vs. 1.0%). In conclusion, the new treatment with as-needed ICS/formoterol only is at least as safe as the previously recommended treatment, regarding adverse effects. ICS/formoterol used as needed and maintenance might give an increased risk of candidiasis and dysphonia, though the absolute risk remains low.