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Asthma Drug Overhaul in Sight

Australians living with mild asthma could soon have a new puffer at their fingertips if results of a research study show the condition can be well managed without daily medication. Asthma experts at the Woolcock Institute of Medical Research in Sydney are testing a new combination puffer treatment that could reduce asthma deaths and change the way the respiratory disease is treated worldwide.

More than a million Australians have mild asthma but most are not receiving treatment based on national guidelines, which recommend they use a daily preventer inhaler.

Instead, most of these people rely solely on a reliever-only medication (a blue inhaler such as Ventolin) which, while it makes them feel better at the time, does not treat the underlying inflammation of the airways and still leaves them at risk of severe flare-ups.

“Sadly, people with apparently mild asthma make up 20 per cent of adults who die of asthma, and a third of people who need emergency asthma treatment,” says asthma specialist Associate Professor Helen Reddel, who is heading the study in Australia. “Clearly we need new treatment options that are acceptable to patients, and that will protect them from severe attacks, or worse.”

Novel START is a real-life randomised controlled study that will compare three different treatments over one year. Two of these are currently approved while the third is novel.

One group of patients will use Ventolin only for relief of symptoms, which is what most people with mild asthma currently do. A second group will use Pulmicort, which contains a low dose of the anti-inflammatory medication budesonide, twice a day, plus Ventolin for relief of symptoms; this is the current recommendation based on guidelines. A third group will use a combination Symbicort Turbuhaler, containing both a low dose anti-inflammatory budesonide preventer and a reliever in one inhaler, for relief of symptoms.

“Symbicort is subsidized by the PBS and is widely used by people with more severe asthma. It can be used to relieve symptoms, but only if already prescribed for daily use. Its proposed use solely for the relief of symptoms (without daily treatment) is new,” Associate Professor Reddel explains. “If we can show that it’s an effective new way to manage mild asthma then, taken with the results of other current studies, it’s likely to change the way authorities recommend mild asthma should be treated.”

This international study is being conducted in Australia, New Zealand, United Kingdom and Italy and is fully funded by AstraZeneca, the manufacturer of both Symbicort and Pulmicort. It is, however, important to point out that this study was initiated by the investigators, and not by the manufacturer. The Woolcock team will enrol and manage Australia’s 100 volunteers. Patients will have their lung function and asthma symptoms regularly tested and some will be interviewed to find out what they like or dislike about the treatments. Researchers will be looking for a drop in asthma flare-ups over the course of a year, including severe flare-ups that need treatment with steroid tablets.

Associate Professor Reddel says that if results, to be reported in 2019, show that those on as-needed Symbicort do better than the other two groups, more than a million asthma patients are set to benefit.

“Currently we have a situation where patients with mild asthma don’t want to take a daily preventer medication, because they don’t feel it’s necessary, and their doctors may not prescribe it because they think it won’t be used regularly enough to be effective,” she says. “So we have patients relying on the blue inhaler, which relieves their symptoms for a few hours, but of course it doesn’t treat the underlying airway inflammation.”

“People with untreated airway inflammation, even if their symptoms are usually mild, are at risk of having severe flare-ups, for instance, when they get a cold, ending up in emergency departments around the country.

Statistics show that 35 per cent of adults presenting to emergency departments with acute asthma, 16 per cent of patients with near-fatal asthma, and 15–20 per cent of adults dying of asthma all had symptoms less than weekly in the previous three months.

“Imagine a solution that means you just use your puffer as needed, and it would both relieve your symptoms and protect you from flare-ups. That would be a major shift in the approach to treatment for mild asthma, and one that would be warmly welcomed, I’m sure,” says Associate Professor Reddel.

Researchers for this study are looking to enrol 100 NSW residents with mild asthma who haven’t used a preventer for at least three months to get involved in the study. To enquire about signing up, or if you want more information about the study, please contact 1300 303 725. 

Click here to watch the Channel 9 news report on this potentially revolutionary asthma study. 

About Mild Asthma

  • Two million Australians - one in ten – have asthma, and most have a mild form of the condition.
  • Those with mild asthma develop symptoms, like a wheeze, cough or some breathlessness, from time to time, for instance, when they have a cold, are exposed to allergens or irritants, when they exercise, or during hay fever season, but they don’t usually have symptoms every day.
  • Current asthma guidelines recommend that people who have asthma symptoms twice or more a month should take preventer medication every day to reduce the risk of flare-ups, but most patients opt not to, feeling their symptoms are too infrequent to warrant it.
  • Their preferred treatment, as-needed reliever use, doesn’t treat the underlying condition, leaving the disease poorly managed and the patient at risk of severe flare-ups.
  • Asthma specialists hope a combination treatment that is already widely prescribed as a daily use inhaler will prove effective as an as-needed treatment during the Novel START trial.

About the Woolcock

The Woolcock Institute of Medical Research is one of the world's leading respiratory and sleep research organisations. It has over 200 medical researchers working to uncover the causes of disease, find better treatments and translate these into practice.

Woolcock Institute

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