'Gamechanger' NZ study could transform how asthma is treated

A New Zealand-led study could revolutionise how asthma is treated around the world.

The common respiratory illness is much more effectively treated with a single combination inhaler than the multiple inhalers which are often prescribed by doctors, a new international study conducted by the Medical Research Institute of New Zealand (MRINZ) has found.

Approximately 10 to 15 percent of the world's adult population has asthma, and it's particularly common in New Zealand, where one in six people suffer from the condition.

Most mild asthmatics are currently prescribed a two-inhaler treatment plan: a daily corticosteroid inhaler to keep symptoms at bay, and an 'emergency' bronchodilator inhaler to be taken to relieve symptoms of an attack. This strategy has long been recommended by both international and New Zealand asthma treatment guidelines.

The study, published in the New England Journal of Medicine and presented at the American Thoracic Society Annual Scientific Meeting in Dallas on Monday (NZ time), says in reality many doctors are reluctant to prescribe daily preventer inhalers, and most people with mild asthma don't use them regularly, only using a reliever inhaler when having an attack.

In a randomised trial involving 675 adults from New Zealand, Australia, the UK and Italy, participants were divided into three groups. Over the course of a year, one group used the Ventolin reliever inhaler whenever they had symptoms, one used the Pulmicort preventer inhaler twice daily and Ventolin when they had symptoms, and the third group used a single Symbicort combined preventer-reliever inhaler containing both budesonide and formoterol when they had symptoms.

Those using both Pulmicort and Ventolin were at about half the risk of an asthma attack than those using just Ventolin. Most striking was the revelation that those using the combined inhaler were 60 percent less likely to have an attack than those taking only Ventolin, and 56 percent less likely than those taking Pulmicort every day, with Ventolin when needed.

"The findings from this study are exciting and have the potential to be a gamechanger in the way doctors treat mild asthma," study author and MRINZ director Richard Beasley said.

"This novel approach simplifies treatment as it doesn't require patients to take a preventer inhaler twice daily even when they have no symptoms. 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."

Stuart Jones, medical director of the NZ Asthma and Respiratory Foundation, says the team behind the study deserves congratulations.

"For those with mild asthma, implementation of the study's findings will lead to a reduction in exacerbations, which means less time feeling unwell and more time doing what you enjoy in life, all while using inhaled steroids sparingly".