Extrafine beclometasone/formoterol is non-inferior to budesonide/formoterol as maintenance and reliever therapy (MART) for adult asthma patients and reduces the total carbon footprint of all inhaler-related greenhouse gas (GHG) emissions.

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The effectiveness between the two MART regimens for asthma has not been directly compared. To investigate non-inferiority of Fostair MART (BDP/FF-MART) compared to Symbicort MART (BUD/FF-MART) for exacerbation prevention and asthma control, and the carbon footprint of inhalers after initiation of BDP/FF-MART. A historical cohort study using the Optimum Patient Care Research Database of adults (≥18 years, ≥12 months baseline data) with asthma only who initiated BDP/FF-MART or BUD/FF-MART from July 2012 to Nov 2024. Inverse probability weighting (IPW) was used to balance BDP/FF-MART and BUD/FF-MART groups. 12-month follow-up comparisons used negative binomial regression (exacerbations) and logistic regression (asthma control) with pre-specified one-sided non-inferiority margins of 10% (exacerbations) and 15% (asthma control). Indicative carbon footprint per inhaler was calculated using published data on CO2 equivalent emissions, inhaler life cycle and disposal (exploratory). Of 42,671 patients 62% initiated BDP/FF-MART and 38% initiated BUD/FF-MART. BDP/FF-MART was non-inferior to BUD/FF-MART for both exacerbations (IRR: 0.98 [upper CI: 1.06]) and asthma control (OR: 0.93 [lower CI: 0.88]). Mean carbon footprint from inhalers per person lowered after BDP/FF-MART (pre- vs post-: minimum: 69 vs 59 [kg CO2 eq]; maximum: 136 vs 92). As-needed SABA accounted for 34-54% of this reduction. BDP/FF-MART was non-inferior to BUD/FF-MART for severe exacerbations and asthma control and reduced the total carbon footprint of all inhaler-related GHG emissions.

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