Anti-Inflammatory Reliever Therapy Reduces Airway Inflammation in Adults with Asthma
A new study from the Medical Research Institute of New Zealand (MRINZ) has found that adults with mild-to-moderate asthma who are already using regular inhaled corticosteroids (ICS) can achieve better control of airway inflammation by using the 2-in-1 combination budesonide–formoterol as their reliever inhaler.
The findings, published today in The Lancet Respiratory Medicine, come from the INFORM ASTHMA trial, a 26-week randomised controlled study involving 181 adults with asthma taking maintenance ICS therapy.
The trial compared the use of budesonide–formoterol as a reliever with terbutaline, a traditional short-acting reliever. Participants using budesonide–formoterol experienced a 20% reduction in fractional exhaled nitric oxide (FeNO), a key marker of airway inflammation and the underlying disease process in asthma.
Dr Jonathan Noble, Principal Investigator of the INFORM ASTHMA trial and MRINZ Research Fellow, says the study provides new evidence for a simple and effective treatment strategy.
“This is the first randomised controlled trial to show that adults taking regular scheduled maintenance inhaled corticosteroids can safely use budesonide-formoterol as a reliever to directly reduce airway inflammation, the underlying disease process in asthma,” says Dr Noble. “FeNO is an indicator of airway inflammation and a predictor of asthma exacerbations.”
Higher FeNO levels reflect increased inflammation in the airways, which is associated with a greater risk of asthma attacks. The observed reduction in FeNO demonstrates that budesonide–formoterol reliever therapy addresses the underlying disease process, not just asthma symptoms. The anti-inflammatory effect was evident by 13 weeks and sustained for the full six-month duration of the study.
Lung function and symptom control were similar between treatment groups, adverse events were comparable, and serious adverse events were rare and unrelated to the study medication.
“This approach empowers patients to better manage their asthma on a day-to-day basis,” Dr Noble adds. “It’s simple and effective, while also potentially reducing long-term risks and asthma attacks.”
Professor Richard Beasley, Director of MRINZ, says the findings fill an important gap in asthma treatment evidence.
“Budesonide-formoterol reliever therapy is well known to reduce the risk of asthma attacks compared with traditional short acting relievers such as salbutamol or terbutaline, whether taken alone in mild asthma or alongside maintenance ICS/long-acting reliever therapy in severe asthma,” Professor Beasley says.
“What this study adds is that budesonide-formoterol reliever directly reduces airway inflammation— the underlying disease process — in patients with mild to moderate asthma on maintenance ICS. This is the remaining piece of the jigsaw puzzle that now provides evidence that budesonide/formoterol reliever-based regimens have superior efficacy and safety profile across all asthma severities.”
The findings provide clinicians with a practical, real-world option that complements maintenance ICS therapy and supports patients in taking greater control of their asthma management.
Professor Bob Hancox, Research Professor at the University of Otago and Medical Director of the Asthma and Respiratory Foundation, who was not involved in the study, says the results add to a growing body of New Zealand-led research.
“This is one of a series of important New Zealand-led studies showing that anti-inflammatory reliever therapy achieves better asthma control than traditional approaches to treatment,” Professor Hancox says. “Patients can guide their own treatment and use their inhalers more efficiently to suppress airway inflammation despite using lower doses than traditional treatment.”
The INFORM ASTHMA trial was supported by the Health Research Council of New Zealand and AstraZeneca. It is the fifth in a series of landmark MRINZ randomised controlled clinical trials demonstrating the efficacy and safety of budesonide–formoterol reliever therapy-based treatments in children, adolescents, and adults, and aligns with international recommendations to prioritise 2-in-1 combination inhalers over short-acting reliever therapy.
Read the full The Lancet Respiratory Medicine publication HERE.
