Symptom-driven low-dose inhaled corticosteroid–formoterol use is safe and effective in mild asthma and has been recommended as one of the preferred treatment regimens at steps 1 and 2 in the 2019 update of the Global Initiative for Asthma (GINA). However, there are no data on patient preferences for this regimen. The purpose of this study was to investigate patient preferences between two regimens: symptom-driven budesonide-formoterol versus maintenance inhaled corticosteroid (ICS) with a separate as-needed reliever inhaler.

This study surveyed a subgroup of 306 out of 407 eligible participants in the PRACTICAL study. The PRACTICAL study recruited adults aged 18–75 years with a physician diagnosis of asthma and randomized these participants to budesonide-formoterol as needed or budesonide one inhalation twice a day plus terbutaline as required for relief of symptoms.

This study analyzed the association of participant preferences for combination preventer and reliever as-needed therapy or maintenance ICS with a reliever inhaler and their respective randomized treatment by logistic regression. Participant preferences, satisfaction, beliefs and experiences were recorded using five-point Likert scales and were analyzed by ordinal logistic regression.

Of the 150 randomized to the as-needed budesonide-formoterol group, 135 (90%) preferred the combination preventer and reliever as-needed therapy while 15 (10%) preferred maintenance ICS with reliever inhaler as needed. Furthermore, 63 (40%) of the 156 randomized to the maintenance budesonide plus as needed terbutaline preferred combination preventer and relievers as needed. In contrast, 93 (60%) of those on daily ICS with a reliever as needed preferred this method. Participants randomized to the budesonide-formoterol inhaler as needed reported higher degrees of satisfaction in all three domains investigated (inhaler effectiveness, frequency of use, and speed of onset of the reliever inhaler) than those randomized to maintenance budesonide plus as-needed terbutaline.

This study found that inhaler regimen preference was strongly associated with the treatment to which the participant was randomized. However, this association was much stronger for the budesonide-formoterol as needed, indicating that most patients preferred as-needed corticosteroid-formoterol therapy if they experienced this regimen.

This study incorporated patient preference into a randomized controlled trial, highlighting that factors such as medication preference can influence patient satisfaction and can translate into clinical practice. Use of as-needed treatment of mild asthma in adolescents and adults, similar to current 2019 Global Initiative for Asthma (GINA) guidelines, aligns more closely with patients’ preferences when given the option to use this regimen.