Abstract Introduction Short-acting beta-2 agonist (SABA) monotherapy is mainly used for symptomatic relief of asthma, but it fails to treat the root cause, which is airway inflammation. Recent studies have shown that inhaled corticosteroids (ICS) with SABA more efficiently prevent exacerbations. The evidence gap persists because of the heterogeneity in the outcomes reported. This meta-analysis aims to bridge the gap and compare the effectiveness of as-needed ICS and SABA versus SABA alone in reducing exacerbations of asthma. Methods This meta-analysis involved a comprehensive search from the following databases: PubMed, Embase, ClinicalTrials.gov, and The Cochrane Library (CENTRAL). An extensive search was carried out from inception to October 30, 2025, without any language restrictions. The inclusion criteria were limited to randomized controlled trials (RCTs) comparing inhaled corticosteroid-short-acting beta agonist combination Versus Short-Acting Beta Agonist Alone in Asthma. Screening and data extraction were carried out by two independent reviewers. The outcomes of the data analysis were computed using a random-effects model in Review Manager software (RevMan 5.4, Cochrane Collaboration). Results After a rigorous screening process, 5 RCTs with 5,268 participants were included in our meta-analysis. Patients receiving the ICS-SABA combination therapy experienced a 35% reduction in the odds of time to first severe exacerbation compared with those receiving SABA alone. The pooled odds ratio was 0.65 (95% CI: 0.52-0.81; p = 0.0001), favoring the ICS-SABA group, with low to moderate heterogeneity (I² = 43%). Three trials analyzed patients with ≥1 severe exacerbation; the pooled analysis demonstrated a 68% relative reduction in the odds of the outcome in the ICS-SABA group compared to SABA only, with a combined odds ratio of 0.32 (95% CI: 0.14-0.74; p = 0.007). Heterogeneity was moderate (I² = 48%). The pooled estimate of the overall risk of adverse events indicated no significant difference between intervention and control groups, with an odds ratio of 0.98 (95% CI: 0.88-1.10; p = 0.73). The pooled analysis of serious adverse events showed no statistically significant difference between the intervention and control groups, with a combined odds ratio of 0.99 (95% CI: 0.74-1.31; p = 0.92). Conclusion The ICS-SABA combination significantly demonstrated clear clinical benefit in reducing exacerbation-related outcomes; no significant differences were observed in overall or serious adverse event rates, highlighting the intervention’s favorable balance of efficacy and safety. This abstract is funded by: None
Razzaq et al. (2026) studied this question.