Clinical use of formoterol–budesonide through nebulization in asthma management: a nationwide survey of Indian pulmonologists

Background: Asthma is a chronic inflammatory airway disease associated with substantial morbidity and impaired quality of life. Although inhaled corticosteroid (ICS) and long-acting beta-2 agonist (LABA) combinations remain the cornerstone of therapy, use of nebulized Formoterol–Budesonide (FB) respules may provide an effective alternative for patients with poor inhaler coordination, acute exacerbations, or difficulty using handheld devices. Methods: A nationwide, cross-sectional, questionnaire-based survey was conducted among pulmonologists across India from September 2025 to October 2025. A structured 20-item multiple-choice questionnaire was distributed to pulmonologists through a secure online platform. Data were analyzed using descriptive statistics and expressed as frequencies and percentages. Results: A total of 358 pulmonologists participated. FB respules were prescribed frequently by 58.66% and occasionally by 33.80% of respondents. Moderate-to-severe asthma was the most common indication (42.74%). Therapy was utilized in both acute exacerbation and maintenance settings by 39.66% of respondents. Clinical efficacy was rated as excellent or good by 94.69%, while 87.15% observed improved symptom control compared with conventional inhalers. Rapid symptom relief within 30 minutes was reported by 87.15% of pulmonologists. Better or improved patient adherence was noted by 92.18%, and 85.47% reported reduced oral corticosteroid requirements. Overall tolerability was favorable in 96.09% of responses. Conclusions: Nebulized Formoterol–Budesonide are widely used by Indian pulmonologists and are perceived as an effective, well-tolerated, and adherence-friendly therapeutic option for asthma management across acute and maintenance settings.