Asthma study offers world-first results in continued exploration of combination 2 in 1 ‘Rescue’ inhaler.

A 2 in 1 combination of salbutamol and budesonide, used as an as-needed rescue medicine, has been shown for the first time to significantly reduce the risk of severe asthma attacks.

In the MANDALA trial, patients using the investigational product Airsupra (PT027), which combines salbutamol (marketed as albuterol in the USA) with budesonide, were 26% less likely to experience severe asthma attacks than those using albuterol alone.

These findings were reported by lead author Professor Alberto Papi, of the University of Ferrara in Italy, and colleagues including Professor Richard Beasley, director of the MRINZ. Published in the New England Journal of Medicine on Sunday 15 May, the study was also presented this week at the American Thoracic Society 2022 International Conference.

Asthma is a chronic respiratory disease that affects more than 330 million adults and children worldwide—including over 610,000 in Aotearoa New Zealand, where we have one of the highest rates of asthma in the world. Reducing the risk of asthma attacks is the highest priority for the management of asthma in New Zealand and internationally. As a result, the findings from the MANDALA trial are of both local and global importance.

Inflammation of the airways in the lungs causes asthma symptoms and attacks. For more than 50 years, people with asthma were prescribed a short-acting beta2-agonist reliever inhaler, such as salbutamol, as the best treatment for symptom relief. However, this inhaler does not reduce the inflammation behind symptoms, thus leaving patients vulnerable to potentially life-threatening attacks, which result in hospitalisation and risk of death.

The 2 in 1 combination inhaler has an anti-inflammatory preventer medication added to the reliever inhaler. This allows the patient to control the dose of the preventer medication according to their changing needs, directly treating the underlying increase in airways inflammation that causes worsening symptoms.

Over the last decade, the 2 in 1 combination reliever therapy approach has been established in clinical practice worldwide, with a different combination of the fast-onset and long-acting beta2-agonist formoterol and the preventer medication budesonide.

Landmark clinical trials undertaken by Professor Richard Beasley and the MRINZ research team have shown that a 2 in 1 inhaler, containing budesonide and formoterol, is far more effective than the traditional single reliever inhaler containing salbutamol or terbutaline.