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Combo inhaler a new treatment option for mild asthma
02
Dec

Combo inhaler a new treatment option for mild asthma

Wednesday, December 02, 2020

Australian asthma guidelines have been updated to include a proven new treatment option for Australians living with the mild form of the condition. 

The update, outlined this month in Australian Prescriber, increases asthma medication options for GPs. Patients with mild asthma can now be prescribed as-needed inhaled low-dose combination budesonide/formoterol, taken when they have symptoms, as an alternative to a daily low-dose preventer (inhaled corticosteroid) plus an as-needed reliever-only puffer (short-acting beta2 agonist or SABA).

The change follows a series of international studies, involving the Woolcock Institute of Medical Research in Sydney, that found that in patients with mild asthma, the new regimen is just as effective, or even more effective than the standard treatment without requiring daily preventer use. It lowers the risk of severe flare-ups after even a single day with modestly higher reliever use.

“GPs can now recommend two highly effective treatment options to help patients with mild asthma manage their condition,” says Professor Helen Reddel, Woolcock asthma specialist and a key researcher involved in all the international trials. “Sadly, asthma deaths are still all too common in this group, largely due to patients relying only on a traditional reliever puffer, so we are very pleased that expanded options are now available.”

Between 50 and 70 per cent of Australian adults and adolescents with asthma have mild or infrequent symptoms. However, as Dr Reddel explains, people with mild asthma are still at risk of severe flare-ups, especially if they overuse SABAs. “We know that that people who go through more than two reliever inhalers in a year are twice as likely to wind up in an ER department, and they also have an increased risk of death,” she says. 

Flare-up risk can be reduced by half, or even more, with a daily low-dose preventer treatment, but unfortunately patients rarely adhere to this therapy, leaving them vulnerable to attacks. Additionally, there are concerns that use of oral corticosteroids to manage severe flare-ups, although potentially life-saving at the time, may increase the risk of osteoporosis, pneumonia, cataracts and diabetes down the track. This makes prevention of flare-ups even more important. 

Dr Reddel and colleagues from the Global Initiative for Asthma (GINA), which she chairs, campaigned for many years for studies to investigate the effectiveness of as-needed low-dose budesonide/formoterol as an alternative treatment for patients with mild asthma. She has supervised the conduct of four high-quality clinical trials involving 10,000 people, testing the combination of budesonide, a preventer, and formoterol, a quick-onset long-acting beta2 agonist (LABA), and found the pairing offers rapid symptom relief and reduces the risk of severe exacerbations. 

Dr Reddel stressed the importance of explaining the meaning of ‘as-needed’ to patients. “Patients with mild asthma prescribed this treatment should use the combination inhaler in the same way as they would a salbutamol inhaler, that is, to relieve asthma symptoms or when they expect to encounter an asthma trigger,” she says. “That’s very different to how they would typically use a preventer inhaler.”

The article is titled, Updated Australian guidelines on the treatment of mild asthma: What’s changed and why?

The new national guidelines for health professionals, entitled Australian Asthma Handbook, can be accessed here.

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