Lay summary
Asthma attacks are a major source of morbidity and health inequity, with Māori and Pacific peoples experiencing significantly higher rates of attacks and oral corticosteroid (OCS) use. Current treatment guidelines recommend a standard OCS course for all asthma attacks, despite evidence that asthma is a heterogeneous condition with varying inflammatory phenotypes. This “one-size-fits-all” approach leads to unnecessary OCS exposure, increasing the risk of serious long-term complications. Biomarker-guided therapy using accessible point-of-care testing (POCT) offers a personalised approach to asthma attack management. This trial will recruit participants from primary care sites, with stratified randomisation and follow-up outcome assessment. Outcomes include OCS use, treatment failure, asthma control, quality of life, adverse events, and health economics analyses. This project will generate the first NZ-based evidence on biomarker-guided asthma attack management, informing clinical guidelines and reducing unnecessary OCS use. It introduces a new health delivery pathway using POCT to manage asthma attacks in primary care, potentially improving access to appropriate asthma treatments, timeliness of care and reduced healthcare costs.