Aotearoa New Zealand Leads The World In Asthma Management

A key report published by the Medical Research Institute of New Zealand (MRINZ) has shown that Aotearoa is leading the world in the adoption of a novel management approach recommended as optimal asthma treatment.

Asthma is a chronic respiratory disease that affects over 610,000 adults and tamariki in Aotearoa New Zealand, where we have one of the highest rates of asthma in the world. Reducing the risk of asthma attacks is the number one priority for the management of asthma in New Zealand and internationally.

In June 2020, New Zealand adolescent and adult asthma guidelines, published by the Asthma and Respiratory Foundation of New Zealand (ARFNZ), recommended that the budesonide/formoterol 2-in-1 combination inhaler, is the preferred reliever treatment for adolescents and adults.

The Patterns of Asthma Medication Use in New Zealand After Publication of National Asthma Guidelines study, undertaken by the MRINZ Asthma Programme research team, investigated whether these guideline recommendations were associated with changes in clinical practice indicated by asthma medication use trends.

The study, published in the renowned Journal of Allergy and Clinical Immunology in Practice has shown that there was a progressive and substantial two thirds increase in the dispensing of the 2-in-1 combination budesonide/formoterol inhaler by New Zealand medical practitioners during the 18-month period after the publication and dissemination of the ARFNZ asthma guidelines recommending its use.

Dr Bryan Betty, Chair of General Practice New Zealand said “Asthma is a condition primarily treated in general practice in New Zealand. This study yet again confirms the high quality of care New Zealanders receive from their general practice teams, with the rapid adoption of world-leading asthma guidelines.

“It is gratifying to see this will lead to overall improvement in management of asthma for those New Zealanders living with asthma.” Dr Betty states.

Landmark clinical trials undertaken by research teams at the MRINZ over the last decade have shown that a 2-in-1 inhaler containing budesonide/formoterol, is far more effective in reducing the risk of severe asthma attacks than the traditional single reliever inhaler such as salbutamol or terbutaline. These MRINZ studies have contributed to the evidence on which the ARFNZ adolescent and adult asthma guidelines recommend this combination inhaler as the preferred reliever medication, across the range of asthma severity.

The 2020 update of the New Zealand adolescent and adult asthma guidelines also recommended a stand-alone stepwise treatment algorithm specifically incorporating the 2-in-1 combination budesonide/formoterol reliever inhaler as the preferred management approach. This novel algorithm has now been adopted by international asthma guidelines and is being implemented worldwide.

Dr James Fingleton, Medical Director of the Asthma and Respiratory Foundation of New Zealand (ARFNZ)says, “This encouraging study from the MRINZ shows that when communicated effectively, guidelines can change asthma management and improve care for our patients. The fact that prescribing patterns started to change so rapidly shows that many GPs and other primary care clinicians are focused on providing the most evidence-based treatment for people with asthma.”

The 2-in-1 combination inhaler enables patients to self-titrate the preventer component of their treatment through the vehicle of their reliever use, thereby reducing asthma attacks by between one and two thirds depending on the underlying severity of their asthma.

This study provides data which suggests that widespread transition to the 2-in-1 budesonide/formoterol reliever therapy regimens in clinical practice can be achieved if recommended and promoted as the preferred therapeutic approach in national asthma guidelines.

Professor Richard Beasley, Director of the MRINZ and asthma programme lead, states that the findings illustrate the high quality of primary care in New Zealand, both general practitioners and practice nurses, who are primarily responsible for the management of almost all people with asthma in New Zealand. “This is a great example of GPs changing their prescribing in accordance with the latest scientific evidence and giving patients the benefit of advances in treatment.” says Professor Beasley. “It also illustrates the leadership role of the ARFNZ in drafting and implementing contemporary asthma guidelines.”

KEY POINTS AT A GLANCE

1. Aotearoa New Zealand is leading the world in the adoption of recommended optimal asthma treatment, shown through a report highlighting the progressive and substantial increase in dispensing of the 2-in-1 combination budesonide/formoterol inhaler during the 18-month period after the publication and dissemination of the NZ asthma guideline
2. The Patterns of Asthma Medication Use in New Zealand After Publication of National Asthma Guidelines study, published in the Journal of Allergy and Clinical Immunology in Practice by the Medical Research Institute of New Zealand (MRINZ), is authored by Lee Hatter, Allie Eathorne, Tom Hills, Pepa Bruce, Claire Houghton, Mark Weatherall, and Richard Beasley.
3. Landmark clinical trials undertaken by research teams at the MRINZ have shown that a 2-in-1 inhaler is far more effective in reducing the risk of asthma attacks than the traditional single reliever inhaler. These MRINZ studies have contributed to the evidence on which the ARFNZ adolescent and adult asthma guidelines have been determined.
4. The 2020 update of the New Zealand adolescent and adult asthma guidelines recommended a stand-alone stepwise treatment algorithm specifically incorporating the 2-in-1 combination budesonide/formoterol reliever inhaler as the preferred management approach. This novel algorithm has now been adopted by the ‘Global Strategy for Asthma’ international asthma guidelines and is being implemented worldwide.
    
5. This study provides data which suggests that widespread transition to the 2-in-1 budesonide/formoterol reliever therapy regimens in clinical practice can be achieved if recommended and promoted as the preferred therapeutic approach in national asthma guidelines.

LINK: https://www.jaci-inpractice.org/article/S2213-2198(23)00525-1/fulltext

BIOS

Medical Research Institute of New Zealand
Rangahautia Te Ora

The Medical Research Institute of New Zealand (MRINZ) is Aotearoa New Zealand’s leading independent medical research institute. MRINZ research is guided by a simple philosophy: it must challenge dogma, increase knowledge, and have the potential to improve clinical practice and outcomes, both in Aotearoa New Zealand, and internationally. Committed to contributing toward a more equitable society that celebrates Te Ao Māori and upholds Te Tiriti o Waitangi, MRINZ’s research teams are dedicated to investigating important public health problems, delivering high quality evidence on which to improve the management of disease and patient care.

Professor Richard Beasley, MRINZ Director, Asthma Programme lead

Richard Beasley, MBChB, MD, DSc, CNZM, is a physician at Wellington Regional Hospital, Director of the Medical Research Institute of New Zealand, Professor of Medicine at Victoria University of Wellington, and Visiting Professor, University of Southampton, United Kingdom. He was previously the Deputy Chair of the Health Research Council of New Zealand. His research interests in respiratory medicine are primarily in the fields of epidemiology and clinical management.

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