A PCORI-funded study found that using inhaled corticosteroids (ICS) with inhaled or nebulized relief medications leads to lower rates of severe asthma exacerbations and reduced asthma symptoms in Black and Latino adults with moderate to severe asthma1,2
In the United States, 25 million people have asthma. Asthma exacerbations result in significant morbidity and mortality, with more than 3,400 deaths attributed to asthma annually. Black and Latino populations experience a disproportionate share of asthma cases and asthma-related sickness. In addition, mortality from asthma is at least twice as high among Black and Latino populations as among White populations.
ICS is typically used daily to control moderate to severe asthma. Many adults with asthma also use quick-relief medications, such as albuterol, to get relief from an asthma exacerbation. A PCORI-funded study examined whether using ICS along with quick-relief medication, in addition to usual daily ICS, improved asthma outcomes among Black and Latino adults, populations that are traditionally underrepresented in asthma research.
In the study, people kept using the daily control strategy prescribed by their clinician. They also continued with whatever quick-relief medication their clinician prescribed, using either an inhaler or a nebulizer. Whenever people used their quick-relief medication, they also took ICS via a separate inhaler. This strategy is known as Patient-Activated Reliever-Triggered Inhaled Corticosteroid (PARTICS).
Findings
A PCORI-funded research study found that ICS along with one-time instructions on its use, when added to usual care, led to a 13% lower rate of severe asthma exacerbations (events requiring systemic steroid therapy or hospitalization) among Black and Latino adults with moderate to severe asthma.
This approach also reduced asthma symptoms, improved quality of life, and reduced the number of missed work or school days or missed activities among this population.
Outcomes
| Finding | PARTICS with usual care versus usual care alone |
| Asthma exacerbations | After 15 months, the annualized rate of severe asthma exacerbations was 0.69 (95% confidence interval [CI]: 0.61, 0.78) in the reliever-triggered ICS group and 0.82 (95% CI: 0.73, 0.92) in the usual care group (hazard ratio [HR]=0.85; 95% CI: 0.72, 0.999; p=0.048). |
| Asthma control* | Asthma Control Test (ACT) scores increased by 3.4 points (95% CI: 3.1, 3.6) in the reliever-triggered ICS group and by 2.5 points (95% CI: 2.3, 2.8) in the usual care group (difference=0.9; 95% CI: 0.5, 1.2). |
| Quality of life† | Asthma Symptom Utility Index scores increased by 0.12 points (95% CI: 0.11, 0.13) in the reliever-triggered ICS group and by 0.08 points (95% CI: 0.07, 0.09) in the usual care group (difference=0.04; 95% CI: 0.02, 0.05). |
| Days missed from work, school, or usual activities | The annualized rate of missed days was 13.4 in the reliever-triggered ICS group and 16.8 in the usual care group (rate ratio=0.80; 95% CI: 0.67, 0.95). |
| Adverse events | Serious adverse events occurred in 12.2% of the participants, with an even distribution between the groups. |
*Higher scores indicate better control. †Higher scores indicate less impairment.
What Do Current Guidelines Say?
This PCORI-funded study was initiated prior to the release of the updated guidelines from the National Asthma Education and Prevention Program of the National Heart, Lung, and Blood Institute.3
The updated guidelines, along with the Global Initiative for Asthma (GINA) guidelines,4 both recommend that people with moderate to severe asthma use ICS and formoterol, a rapid-onset, long-acting beta-agonist (LABA), in a single inhaler for both asthma management and symptom relief.
This approach is known as Single Maintenance and Reliever Therapy (SMART). Note that patients who use SMART should not use a separate ICS or a separate quick-relief inhaler or nebulizer.
Talking with Patients about Treating Moderate to Severe Asthma
View a consumer-friendly version of this Evidence Update to help support clinicians’ conversations with patients about treating moderate to severe asthma. Topics to discuss with patients may include:
➤ How taking ICS with their relief medication, when they are already taking ICS daily, may result in better asthma outcomes
➤ Why they still need to take ICS or ICS-LABA for daily control, even if they add ICS to their relief medication
➤ How to add ICS when using a nebulizer for quick relief
➤ The importance of checking in periodically with their clinician to assess their asthma symptoms and how well the approach outlined in their Asthma Action Plan is working
About the Study
In this study, the research team randomly assigned 1,201 Black and Latino adults with moderate to severe asthma to use PARTICS plus usual care or to continue usual care alone. All participants lived in the continental United States or Puerto Rico. Participants received one instructional visit during which they were taught to take one puff of ICS for each puff of inhaled relief medication or five puffs of ICS for each nebulized relief medication.
Through 15 monthly questionnaires, the research team assessed the rate of asthma exacerbations, monthly asthma control, quality of life, and participant-reported missed days of work or school and missed usual activities. The team also assessed the safety of using additional ICS.
Read more about this study at www.pcori.org/Israel494
PCORI produced this Evidence Update in collaboration with the Allergy & Asthma Network.
SOURCES
1. © 2011–2025 Patient-Centered Outcomes Research Institute. “Comparing Ways to Decrease Severe Asthma Attacks among Black and Latinx Adults with Moderate to Severe Asthma -- The PREPARE Study.” Updated October 18, 2024. https://www.pcori.org/Israel494
2. Israel E, Cardet JC, Carroll JK, et al. Reliever-triggered inhaled glucocorticoid in Black and Latinx adults with asthma. N Engl J Med. 2022;386(16):1505-1518. https://doi.org/10.1056/NEJMoa2118813
3. Cloutier MM, Baptist AP, Blake KV, et al. 2020 Focused updates to the Asthma Management Guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146(6):1217-1270. https://doi.org/10.1016/j.jaci.2020.10.003
4. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2024. Updated May 2024. https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf
The information in this publication is not intended to be a substitute for professional medical advice. This update summarizes findings from a PCORI research award to Partners Healthcare Brigham and Women’s Hospital.
Posted: Feb. 28, 2025