21 May 2018

‘As-needed’ works just as well for mild asthma

Chronic Disease Clinical Respiratory

Asing a combination drug inhaler as a reliever medication is an effective way to prevent severe asthma exacerbations in patients with mild asthma, a new international study suggests.

Patients with mild asthma who only took a combination drug inhaler as needed were equally well protected against severe asthma attacks as patients who took daily preventer medication, researchers reported in the New England Journal of Medicine.

Irregular use of the combination drug, budesonide-formoterol, provided less symptom control than taking budesonide twice daily, but the risk of having a severe asthma attack over a 12-month period was similar (non-inferior) across the 4,000 people included in the study, which was funded by AstraZeneca. 

The combination inhaler that contains budesonide, as well as formoterol (a rapid-onset long-acting beta2 agonist), deals with some of the underlying factors contributing to asthma, while also providing immediate symptom relief. 

Patients with mild asthma often did not adhere to daily treatment as the risk of exacerbations seemed remote, the authors said. 

“The addition of a controller with an anti-inflammatory reliever leverages the patient’s tendency to prefer a reliever agent,” they said.

While these kind of combination inhalers were available in Australia, they were not currently indicated for this use in patients with mild asthma,  Siobhan Brophy, the CEO of the National Asthma Council Australia, said.

For most adults with asthma, the Australian Asthma Handbook recommended a regular low-dose steroid preventer with the use of as-needed reliever.

“Combination medication … is recommended only for patients whose asthma remains uncontrolled with this [regular steroid and as-needed reliever] management,” Ms Brophy said.

But the alternative approach presented in the study might be considered if it was proven to be as effective as the existing treatment, she said.

“This study certainly opens up another potential treatment option for asthma and we look forward to seeing more clinical evidence and outcomes in due course,” Ms Brophy said.

NEJM 2018, 16 May