August 25, 2019
“One of the fantastic things about doing clinical research in New Zealand is that we have such support from the Asthma Community… we had 890 New Zealanders who volunteered and took part in this study for a twelve-month period.”
The treatment strategy that was investigated in this study has already been approved as a new form of treatment for Asthma, which Professor Beasley expects will be a welcome change for doctors and patients alike. “This rapid approval reflects the burden of Asthma in New Zealand and the priority [of the health officials and clinicians] to improve outcomes”.
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.”
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.