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Background Triamcinolone acetonide (TAA) inhalation aerosol (Azmacort Inhalation Aerosol), a well-established corticosteroid treatment for bronchial asthma, utilizes the chlorofluorocarbon (CFC) propellant P-12, which will be phased out because of environmental concerns. Two TAA aerosol formulations have been developed using a non-chlorofluorocarbon propellant, HFA-134a (Azmacort HFA Inhalation Aerosol delivering TAA 75 μg/puff or 225 μg/puff). Objective This study compared the efficacy and safety of the new 225 μg/puff formulation (TAA-HFA 225) to the marketed TAA inhalation aerosol (TAA-CFC) and to placebo in adult patients with moderate-to-severe persistent asthma. Methods After a 5-day to 21-day baseline period during which all patients received TAA-CFC 150 μg/day, 538 patients were randomized to one of the following treatment schedules: TAA-HFA 450, 900, or 1800 μg/day; TAA-CFC 450 or 900 μg/day; or placebo for 12 weeks. Results All active treatment groups showed statistically significant improvement compared with placebo in pulmonary function (FEV1, FEF25-75%, morning and evening PEF), use of rescue albuterol, and asthma symptom scores. Improvements in all variables occurred within 1 week of treatment. Conclusions The TAA-HFA 225 exhibited similar safety and efficacy profiles to the two equivalent doses of TAA-CFC studied. Our findings indicate that TAA-HFA is a safe and effective replacement for the currently marketed CFC-containing product. The higher strength 225 μg/puff formulation provides effective control of asthma with fewer inhalations.