The Woolcock Institute of Medical Research

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Daily Puff Protects Mild Asthmatics from Deadly Wheeze

Friday, January 06, 2017

Hundreds of thousands of Australians with mild asthma could halve their risk of a severe flare up with a low-dose daily puffer, a ground-breaking new analysis has found.

Work led by Sydney’s Woolcock Institute of Medical Research and published in the prestigious international medical journal The Lancet, is challenging the long-standing assumption that it’s okay to leave mild asthma untreated.

The study found that people experiencing asthma symptoms less than two times a week can halt lung decline and protect themselves from asthma attacks and severe wheezing by taking low dose preventer medication every day. “The benefits were seen even in people with very infrequent symptoms, once a week or less, suggesting there is a lot to gain from getting even the mildest of asthma sufferers onto treatment,” says study leader Professor Helen Reddel.

About a million Australians have mild asthma but most are not being treated according to the national guidelines which recommend they use a preventer inhaler every day, even when they have no symptoms. Instead, most of these people resort to reliever-only medication – the ‘ambulance at the bottom of the cliff’ solution – which leaves their condition poorly managed.

Without their condition in check, sadly many adults with mild asthma end up in hospital with an attack they could have prevented, and some of these attacks can be fatal,” Professor Reddel says.  

Woolcock researchers set out to investigate whether people with mild asthma could benefit from daily low dose preventer medication. They analysed the results of the randomized inhaled Steroid Treatment As Regular Therapy (START) which assessed outcomes for 7,138 mild asthma patients.

Half were given the once-daily anti-inflammatory treatment budesonide, or Pulmicort, while the remainder took a placebo puffer. Results showed that over three years, Pulmicort halved the risk of severe flare-ups, reduced lung function decline, and improved symptom control. “These results are strong enough to be recommending that even those with the mildest form of asthma start taking a low dose medication every day,” the researcher says.

But the solution is not that simple. Professor Reddel highlights that people with asthma who have few symptoms are reluctant to take daily medication, and GPs are often not keen to prescribe it, largely because many don’t understand how dangerous mild asthma can be. This was seen dramatically in the epidemic of thunderstorm asthma in Melbourne last year.

With this in mind, Professor Reddel and her team have set to work testing an ‘on demand’ inhaler treatment called Symbicort, currently prescribed for patients with moderate or severe asthma, that can be used when symptoms appear. This study, called Novel START, is in still in recruitment phase in New Zealand, Australia, Italy and the United Kingdom, but if successful, it could change the way the respiratory disease is treated worldwide.

Both studies are fully funded by AstraZeneca, the manufacturer of both Symbicort and Pulmicort, but both studies were initiated by external researchers.

Our new results show how preventer medication can benefit even mild asthma, leaving us more driven than ever to find an effective as-ended treatment that patients will actually use.”

People with mild asthma should talk to their GP about trying a low dose preventer treatment, and make sure that they have a written asthma action plan. People in Sydney and Newcastle who are using only a blue reliever inhaler can volunteer to help the Woolcock team investigate an alternative way of managing their mild asthma.

To volunteer for the Novel START study please click here to register online.

Click here to find out more about this study. 

About Mild Asthma

  • Two million Australians - one in ten – have asthma, and about half have a mild form of the condition.
  • Those with mild asthma develop symptoms, like wheezing, cough or breathlessness, from time to time, for instance, when they have a cold, when they exercise, or during hay fever season.
  • About one third of people presenting to Emergency Departments with severe asthma flare-ups report having symptoms less than weekly in the previous 3 months. 
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