A large New Zealand clinical trial has provided new evidence that using two types of common asthma medications combined in one inhaler for both preventive and rescue treatment (Single inhaler Maintenance And Reliever Therapy: SMART) is more effective at reducing severe attacks of asthma than conventional asthma management, and has a favourable safety profile.
This study, based at the Medical Research Institute of New Zealand (MRINZ) and funded by the Health Research Council of New Zealand, was published in the new journal Lancet Respiratory Medicine today.
On behalf of the study team, Professor Richard Beasley, who conceived the study with the late Professor Peter Black from the University of Auckland, commented that “this study represented a collaboration among many different research-based groups in New Zealand. An important part of the design was the incorporation of electronic monitors on the patients’ inhalers, providing the ability to measure actual medication use, crucial to the assessment of risk with the treatment regimes used".
The electronic monitors were developed and provided by Nexus6, a medical technology company based in Auckland. In addition to the MRINZ, patients were recruited from a network of primary care clinics, including Tauranga Central Med, Papamoa Pines Medical Centre and Henderson Medical Centre, and the Tu Kotahi Maori Asthma Trust in the Hutt Valley.
"Use of this network of primary care and Maori health clinics ensured that the results are widely applicable to at-risk patients and provides a model for future studies of this kind,” said Professor Beasley.
Currently, medical guidelines recommend that adult patients with inadequately controlled asthma are prescribed an inhaled corticosteroid (ICS) plus a long-acting beta agonist (LABA) combination inhaler to use as regular maintenance therapy, with a short-acting beta agonist inhaler for rescue use to treat symptoms. In contrast, the SMART regime uses the single ICS/LABA inhaler for both maintenance and relief treatment.
In this study the budesonide/formoterol (ICS/LABA) inhaler prescribed according to the SMART regime reduced the risk of severe asthma attacks without increasing the risk of beta agonist overuse or increasing long-term corticosteroid exposure.
With the help of electronic monitoring of medication use, it was observed that the number of days of high use, marked overuse and extreme overuse of beta agonists were about 40 per cent lower in the group taking SMART compared with the group given standard treatment. Importantly, the use of the SMART regime did not lead to a greater delay in seeking medical assistance in the setting of a severe attack, a common factor that contributes to the risk of a fatal outcome.
Professor Beasley said “the results show that the SMART regime has a favourable risk/benefit profile compared with standard maintenance treatment and can be recommended for use in adults at risk of severe asthma exacerbations”.
News article courtesy of the Medical Research Institute of New Zealand.