Comparison of Budesonide/ Formoterol Fumarate and Fluticasone Furoate/ Vilanterol for Asthma Control.

Introduction: Inhaled corticosteroid (ICS) and long-acting \beta_2-agonist (LABA) combinations are central to moderate-to-severe persistent asthma management. Budesonide/Formoterol (BUD/FOR) and Fluticasone Furoate/Vilanterol (FF/VI) differ fundamentally in dosing frequency, receptor binding affinity, and delivery devices. Objectives: To evaluate and compare changes in asthma symptom control using the Asthma Control Test (ACT), pulmonary function parameters via spirometry (PFT), and inhaler compliance using the Test of Adherence to Inhalers (TAI) between BUD/FOR and FF/VI regimens Methods: An ambispective observational study was conducted at Lourdes Hospital, Ernakulam, comprising 130 adult asthma patients (BUD/FOR: n = 62; FF/VI: n = 68). Patients received face-to-face inhaler technique counseling augmented by a QR-code instructional leaflet. Clinical outcomes were evaluated at baseline and after 3 months of follow-up using spirometric parameters (FVC, \text{FEV}1, \text{FEV}_1/\text{FVC}, \text{FEF}{25\text{--}75\%}, \text{FEF}_{75\text{--}85\%}), the 5-item ACT survey, and the 12-item TAI questionnaire. Data were analyzed using paired/independent t-tests and Fisher's exact tests. Results: Both cohorts showed significant baseline-to-endpoint gains in FVC and \text{FEV}1 (p < 0.01). FF/VI demonstrated superior small-airway improvements, with significant increases in \text{FEF}{25\text{--}75\%} (58.21 \pm 19.80\% to 72.79 \pm 17.67\%, p = 0.0001) and \text{FEF}_{75\text{--}85\%} (p = 0.048), whereas BUD/FOR showed no significant small-airway change (p = 0.137). Well-controlled asthma (\text{ACT} \ge 20) was achieved by 67.6\% of patients in the FF/VI cohort compared to 46.9\% in the BUD/FOR cohort. Categorical adherence improvement on the TAI scale reached statistical significance only in the once-daily FF/VI group (p = 0.0001; BUD/FOR: p = 0.613). Conclusions: While both combinations provide robust bronchodilation and symptom relief, once-daily FF/VI demonstrated superior small-airway recovery, higher rates of categorical symptom control, and statistically significant enhancements in inhaler adherence relative to twice-daily BUD/FOR.