The biggest change in asthma management for decades is underway, with expert groups warning against the use of short-acting beta2 agonists on their own.

The mainstay of treatment in adults with mild disease is putting them at increased risk of death from asthma, says Professor Andrew Bush, a respiratory physician at the Royal Brompton Hospital, UK, and former head of the Paediatric Assembly of the European Respiratory Society.

He pulls no punches in his Lancet Respiratory Medicine commentary on a major study released in May in the New England Journal of Medicine, which found treatment of mild asthma was best with an as-needed combination of an inhaled corticosteroid and long-acting beta2 agonist (ICS-LABA).

The trial reported that as required budesonide-formoterol was better than either usual treatment with salbutamol (SABA) alone as required, or ongoing budesonide in combination with as-needed salbutamol, for preventing severe exacerbations in 675 people aged 18-75 with mild asthma.