Albuterol–Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma

Abstract

To the Editor: In the MANDALA trial, Papi et al. (June 2 issue)¹ showed the superiority of high-dose budesonide–albuterol to albuterol as reliever therapy for reducing exacerbations in patients with uncontrolled moderate-to-severe asthma. Only 27% of the patients were receiving high-dose inhaled glucocorticoid–long-acting β₂-agonist (LABA) therapy at baseline, and the presence of a mean forced expiratory volume in 1 second (FEV₁) of 64% of the predicted value and a mean reversibility in FEV₁ of 28% indicates that there was considerable room for improvement. Would budesonide–albuterol therapy have been as effective in patients whose inhaled glucocorticoid–LABA therapy had been sufficiently adapted . . .