Adults with Asthma Reduce Steroid Use and Improve Control with New Stepwise Approach

A new study led by the MRINZ has found that adults with asthma can safely simplify their treatment, reduce their exposure to steroids, and improve asthma control using a structured, stepwise Anti-Inflammatory Reliever (AIR) Algorithm.

The findings, published inThe Lancet’s eClinicalMedicine, come from the Anti-Inflammatory Reliever Algorithm trial – a 52-week open-label study involving 100 adults aged 18–75 years with mild, moderate, or severe asthma.

Participants began treatment with a combination 2-in-1 budesonide–formoterol inhaler, starting at one of three treatment steps according to the severity of their asthma. They then followed a practical stepwise algorithm, adjusting their treatment up or down in response to reliever use and asthma attacks. During the first half of the study, participants were guided by doctors; in the second half, they made these adjustments themselves.

The stepwise approach resulted in a clinically important increase in patient satisfaction. By week 52, 60% of participants had transitioned to the lowest treatment step, using budesonide–formoterol solely as needed, compared with 25% who started the trial at this step. This meant a marked reduction in overall exposure to inhaled steroids, demonstrating the safety benefits of this approach. Despite stepping down treatment, participants experienced significant improvements in asthma symptom control and quality of life, with no deterioration in lung function.

Dr Pepa Bruce, lead author of the study, said, “Our findings show that a stepwise anti-inflammatory reliever strategy allows adults to take control of their asthma simply and safely. It works across a wide range of asthma severities and improves asthma control and quality of life, while decreasing the risk of side effects from medication.”

The study also provided important insights into patients’ perceptions of the AIR Algorithm approach. During the trial, participants grew more confident in AIR therapy with budesonide–formoterol reliever and had fewer concerns about it. Most felt it worked better than their previous treatment, highlighting that it’s easy to use and likely to encourage consistent adherence.

Professor Richard Beasley, Director of MRINZ, states, “AIR therapy with budesonide-formoterol reliever has been shown to reduce the risk of asthma attacks compared with the traditional salbutamol reliever at every treatment step. What this study adds is that patients taking budesonide-formoterol can move between steps using a simple algorithm as their asthma severity changes. The AIR approach empowers patients to self-manage and gives clinicians a real-world, evidence-based pathway for safer asthma care.”

Trial participant Andrew Craig said, “The protocol was easy to follow, and gave me confidence that I could self-manage my treatment, adjusting up and down as needed. The benefits of following the algorithm were apparent when my asthma severity increased slightly following my first bout of COVID. I was able to adjust my dose and get back under control, and having guidelines about when to seek GP advice gave me peace of mind. My asthma went from being something I always had in the back of my mind to something I rarely have to think about.”

Professor Bob Hancox (University of Otago and Medical Director of the Asthma and Respiratory Foundation), who was not involved in the study, says, “For years we have been telling people how much asthma medication to take and when to take it. This study shows that if we give people an Anti-inflammatory reliever inhaler and the right advice, people can adjust how much they need according to their symptoms. They end up needing less medication overall, have better asthma control, and a better quality of life.”

The AIR Algorithm trial was supported by the Health Research Council of New Zealand and AstraZeneca. It represents the latest in a series of five landmark studies investigating the efficacy and safety of budesonide–formoterol reliever therapy-based treatments in children, adolescents, and adults.

Read the full media release HERE and view The Lancet eClinicalMedicine publication HERE.