Children aged five to 15 years with mild asthma using budesonide-formoterol inhalers experienced a 45% reduction in asthma attacks compared to children using salbutamol inhalers, the current global standard of care, in a landmark study published in The Lancet in September 2025.
The CARE (Children’s Anti-inflammatory REliever) trial reported 18 fewer attacks per 100 children per year among those using budesonide-formoterol inhalers. These children also had better overall asthma control with less night waking and daytime asthma symptoms compared to the children using salbutamol inhalers.
For decades, children with asthma have been prescribed short-acting beta-agonists (SABAs) like salbutamol (the blue puffer), for quick relief of symptoms. However, reliance on SABAs alone does not address the underlying problem and is associated with an increased risk of severe asthma attacks and death. In contrast, in recent years adults have benefited from updated global guidelines that recommend budesonide-formoterol as the preferred inhaler.
The Forum of International Respiratory Societies (FIRS),* Increasing Access to Inhaled
Medicines campaign has highlighted the lack of access to affordable, effective inhaled medicines for children with asthma, and is calling on governments, industry, and global health agencies to work together to ensure that budesonide-formoterol inhalers are:
1. Included in global and national pediatric asthma guidelines and essential medicine lists for children, aligning asthma care with that of adults as recommended by the Global. Initiative for Asthma (GINA)
2. Available in at least 80% of primary health care facilities by 2030, as per the target in the global NCD Action Plan and the UN Political Declaration on NCDs
3. Affordable to all families raising a child with asthma by being included on national health insurance reimbursement lists and other proven strategies
4. Delivered by health workers educated in their use and trained in appropriate inhaler and spacer technique
5. Incorporated into efforts to increase community awareness of inhalers and to destigmatize and improve their correct use among children
Asthma remains one of the most common chronic diseases of childhood, affecting over 100 million children under 15 and taking 12,000 young lives each year. Increased access to affordable budesonide-formoterol inhalers will deliver considerable health and economic benefits by reducing the number of severe attacks, emergency visits, and school days lost, enabling children to live healthier, more productive lives.
The CARE trial was led by the Medical Research Institute of New Zealand (MRINZ) in collaboration with Imperial College London, University of Otago Wellington, Starship Children’s Hospital, and the University of Auckland.
This Statement was developed by the FIRS Working Group on Increasing Access to Inhaled Medicines for COPD and Asthma led by Professors David Halpin, Fellow, Royal College Physicians, Member, British Thoracic Society (BTS), European Respiratory Society (ERS), American Thoracic Society (ATS),
International Union Against Tuberculosis and Lung Disease (The Union), Member of Board of Directors of Global Initiative for Chronic Obstructive Lung Disease (GOLD), and Professor, University of Exeter, United Kingdom; Guy Marks, President, The Union, Board of Directors, NCD Alliance, President, FIRS, Professor, UNSW Sydney, and Honorary Professor, University of Sydney, Australia; and Heather Zar, Professor and Chair, Department of Paediatrics and Child Health, University of Cape Town, South Africa.
All inquiries: Leith Greenslade, leith@justactions.org