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Ground-breaking Kiwi study to transform asthma treatment worldwide

Fuseworks Media
Fuseworks Media

New findings from a ‘landmark’ New Zealand study have provided the compelling evidence needed to change how doctors treat the world’s most common respiratory illness.

Around 10-15% adults worldwide suffer from asthma - 1 in 6 New Zealanders (around 830,000) live with the disease daily. Now a new, fully independent study of nearly 900 New Zealand patients with mild to moderately severe asthma, conducted by the Medical Research Institute of New Zealand (MRINZ), has found that a simplified, combined inhaler treatment cuts the risk of severe asthma attacks by one third compared to other commonly prescribed treatments.

"The findings from this study are incredibly exciting and will undoubtedly change the way doctors treat mild and moderate asthma worldwide" says study author and MRINZ Director Professor Richard Beasley. "The results provide new evidence supporting recent major changes in the management approach recommended in international asthma guidelines".

Currently, most adults with mild to moderate asthma take two different inhaler medications; a preventer (an inhaled corticosteroid) taken twice daily to keep symptoms at bay and a separate reliever (an inhaled bronchodilator) taken whenever needed to relieve asthma symptoms such as wheezing. However, in reality, patients are not likely to use them regularly if their asthma symptoms are infrequent, thereby limiting their benefit.

This new study, fully-funded by New Zealand’s Health Research Council (HRC) and published in the prestigious Lancet medical journal, shows that the use of a combined preventer and reliever in the one inhaler, taken only when needed to relieve symptoms, reduces the risk of an asthma attack by around one-third compared with the use of a separate preventer inhaler taken twice daily together with a reliever inhaler as-needed.

The year-long controlled trial involved 890 adults from 15 sites in New Zealand, randomly assigned into one of two groups. One half were asked to use both the preventer inhaler budesonide (Pulmicort) twice daily as well as a separate terbutaline (Bricanyl) inhaler whenever they had symptoms; the other half were asked to just use a single combined preventer-reliever inhaler containing both budesonide and formoterol (Symbicort) whenever they had symptoms. The most striking finding was that in the latter combined preventer-reliever inhaler group, the risk of severe asthma attacks was reduced by 31% compared to the group using the preventer inhaler every day plus the reliever inhaler for symptom relief.

"This trial has confirmed our study published earlier this year in the New England Journal of Medicine, showing that when patients take just a single combined preventer-reliever inhaler whenever needed to relieve symptoms, they do a lot better than the previously recommended treatment of a regular preventer inhaler taken twice daily plus a reliever inhaler whenever needed" says Professor Beasley. "The greater benefit was achieved despite exposure to about half the amount of inhaled corticosteroid preventer medication because the inhaled corticosteroid works better when taken as needed in mild asthma".

"This novel approach simplifies treatment as it doesn’t require patients to take a preventer inhaler twice daily even when they have no symptoms" he says. "It also addresses two key problems in asthma management; the reluctance of doctors to prescribe regular preventer inhaler therapy and the reluctance of patients to use it when they feel well. With a combined preventer-reliever inhaler, patients have more personal and immediate control over their asthma management. This takes advantage of the patient’s natural behaviour to take a reliever only when they are experiencing symptoms".

Otago University researcher and Dunedin Hospital Respiratory Specialist Dr Ben Brockway believes this study is a major step forward for asthma management internationally.

"This independent study is important as it adds to a strengthening body of work showing that "take a puff when you feel you need it" combination treatment is equivalent or better than regular preventer use for reducing asthma flares, but with a lower total burden of treatment" says Dr Brockway. "People can worry about taking inhaled steroids regularly, but if you are an adult with asthma and struggle to remember to take your preventer inhaler, or only have a reliever inhaler, then there’s a very good chance that this simpler, easier regime will improve your asthma control".

New Zealand’s Health Research Council (HRC), which fully funded the study, says the findings have the ability to improve the lives of patients internationally.

"This research team has identified a simpler way to manage asthma because they questioned the status quo," says the HRC’s acting chief executive, Dr Vernon Choy.

"We aim to support research that translates to real-world benefits, and this is one of those studies that could make a genuine difference for New Zealanders and people who live with asthma worldwide," he adds.

Professor Beasley says we’re now close to asthma treatment being the use of a single preventer-reliever inhaler for nearly all patients across the spectrum of asthma severity. In mild to moderate asthma, patients would simply take this combined preventer-reliever inhaler when they have symptoms with no requirement for other inhalers. In severe asthma, patients would take the combined preventer-reliever inhaler daily both as a regular maintenance medication and also as a reliever when needed.

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