For parents of children with asthma, a nighttime cough or sudden bout of wheezing can be worrying. A reliever inhaler may ease breathing quickly, but families also need to know whether their child’s treatment is helping prevent future attacks.
New research offers encouraging evidence. The CARE trial, published in The Lancet in 2025, found that a combination inhaler containing budesonide and formoterol reduced asthma attack rates in children with mild asthma compared with salbutamol alone.
The findings could influence how doctors approach childhood asthma, particularly for children who rely on a reliever inhaler without regular anti-inflammatory treatment. However, the results do not mean every child should immediately switch inhalers. Treatment still needs to be tailored to the child’s age, symptoms and medical history.
What Did the CARE Trial Find?
The Children’s Anti-Inflammatory Reliever (CARE) trial followed 360 children aged 5 to 15 with mild asthma for 52 weeks. Participants received either an as-needed budesonide-formoterol combination inhaler or salbutamol alone for symptom relief.
Researchers recorded an annualised asthma attack rate of 0.23 per participant in the combination-inhaler group, compared with 0.41 in the salbutamol group. That represents a 45% lower rate of asthma attacks in the combination group.
The researchers also found similar overall rates of adverse events between the two groups.
Importantly, the study compared two reliever strategies in children who had been using salbutamol alone. It did not establish that the combination inhaler is the best option for every child with asthma, regardless of their existing treatment.
Read the CARE trial in The Lancet.
Why Is a Combination Inhaler Different?
Asthma involves more than the temporary tightening of the airways. Inflammation inside the breathing passages can cause swelling, sensitivity and increased mucus production, making breathing difficult.
Salbutamol, also known as albuterol in some countries, is a short-acting bronchodilator. It relaxes the muscles around the airways, helping them open and easing symptoms. However, it does not treat airway inflammation.
Budesonide is an inhaled corticosteroid that reduces inflammation. Formoterol is a bronchodilator that relaxes airway muscles and acts relatively quickly.
Combining these medicines means that symptom relief and anti-inflammatory treatment can be delivered together when the prescribed inhaler is used.
This approach is often described as an anti-inflammatory reliever (AIR). When an inhaler is prescribed for both regular maintenance and symptom relief, the regimen may be called maintenance-and-reliever therapy (MART).
Although the terms are related, they describe different treatment plans. They should not be used interchangeably without considering how the medicine is prescribed.
Does This Mean the Blue Inhaler Is Outdated?
Not necessarily. The CARE results strengthen the evidence for combination reliever treatment in children with mild asthma who would otherwise use salbutamol alone. But asthma guidelines take account of several factors, including age, disease severity, available inhaler formulations and the child’s current treatment.
The Global Initiative for Asthma’s 2026 strategy report discusses the CARE findings and recognises the reduced attack rate. It also notes that the specific formulation used in the trial has been discontinued and that evidence gaps remain for some treatment choices in children aged 6 to 11.
For some children, an inhaled corticosteroid taken regularly alongside a separate reliever remains an appropriate option. Others may benefit from a prescribed combination regimen.
Parents should not discontinue a child’s existing preventer or replace a rescue inhaler without consulting the child’s healthcare professional. Not every combination inhaler is suitable for use as a reliever.
Explore the GINA 2026 asthma strategy.
What About Growth and Side Effects?
Parents may understandably worry about inhaled corticosteroids and their child’s growth. These medicines are important for controlling airway inflammation, and the benefits of preventing asthma attacks need to be weighed against potential side effects.
In the CARE trial, researchers found no difference in growth velocity between the treatment groups over the study period. That is reassuring, although a one-year study cannot answer every question about long-term treatment.
Inhaled corticosteroids can sometimes cause a sore throat, hoarseness or oral thrush. Using the prescribed inhaler correctly and rinsing the mouth after corticosteroid doses can help reduce local side effects.
Doctors generally aim to use the lowest effective treatment dose that keeps asthma well controlled. Families should discuss any concerns about growth, side effects or frequent symptoms rather than reducing medication on their own.
What Should Parents Do Now?
If a child has asthma, a useful next step is to review their current treatment and asthma action plan with their doctor.
Consider discussing:
- How often the child needs a reliever inhaler, including at night or during exercise.
- Whether coughing, wheezing or breathlessness suggests that asthma is not well controlled.
- Whether an anti-inflammatory reliever or another inhaled corticosteroid-based plan is suitable for the child’s age and symptoms.
- Whether the child uses the inhaler correctly and needs a spacer.
- What to do if symptoms worsen or the usual reliever does not provide adequate relief.
A child who is struggling to breathe, cannot speak comfortably because of breathlessness, or is becoming unusually drowsy needs urgent medical attention. Follow the child’s emergency asthma plan and seek emergency help when indicated.
A Promising Step Forward
The CARE trial adds important evidence to the evolving conversation about childhood asthma treatment. Its findings suggest that delivering anti-inflammatory medicine alongside symptom relief can reduce asthma attacks in children who would otherwise rely on salbutamol alone.
The key message is not that every child needs the same inhaler. It is that asthma care should address both immediate symptoms and the underlying inflammation that contributes to attacks.
For families, a treatment review with a healthcare professional can help ensure that a child’s plan reflects the best available evidence—and gives them the support they need to play, learn, sleep and stay active with greater confidence.
Photo by Cnordic Nordic: https://www.pexels.com/photo/close-up-of-an-inhaler-in-use-indoors-29702934/