Study reveals alternative treatment for mild asthma

A new study led by a Hamilton researcher has found an alternative treatment for people with mild asthma who have trouble taking their inhaler every day.

The findings show the best option is the often-prescribed steroid inhaler used daily — usually twice. But fewer than 20 per cent of patients follow this routine, according to Dr. Paul O’Byrne, the principal investigator of the study and a respirologist.

For those who only use their inhalers when they’re having an asthma attack, the research published Wednesday in the New England Journal of Medicine revealed a combined-drug inhaler that includes a steroid to control inflammation is a “much better choice” than the rescue inhalers typically used.

“I think this is going to actually change the way we manage asthma,” said O’Byrne, a professor at McMaster University’s Michael G. DeGroote School of Medicine.

“Most people with asthma consider their asthma to be mild and only use the reliever medication as their only treatment.

“What we’re saying in this study, is that’s the wrong approach. That gives you the worst outcomes.”

The international study saw O’Byrne, a clinician scientist at the Firestone Institute for Respiratory Health at St. Joseph’s Healthcare Hamilton, and a team of researchers conduct a 52-week trial with patients 12 and older who had clinically diagnosed mild asthma.

More than 3,800 patients from countries including Canada, China, the United Kingdom and Australia participated in the study, which was conducted between July 2014 and August 2017.

Patients were broken into three groups — those who were given a twice-daily placebo plus a relief inhaler as needed; those given a twice-daily placebo plus the combined-drug inhaler; and those following a twice-daily treatment regimen plus a relief inhaler if needed. All received an electronic reminder about their treatment twice a day.

The trial results showed using the combined-drug inhaler was a “much better” choice than the rescue inhaler when it comes to symptom control, said O’Byrne. It also reduced the risk of an asthma attack by more than 60 per cent.

But the best option was the regular, twice-daily inhaled steroid.

O’Byrne is also an author on a parallel study led by Dr. Eric Bateman at the University of Cape Town, which was also published in the New England Journal of Medicine on Wednesday.

The findings showed using the steroid inhaler when needed was comparable to the twice-daily inhaled steroid for severe asthma attacks but did not control symptoms as effectively.

“I think the next study (that) needs to be done is taking this into truly a real world setting because the benefit with the regular inhaled steroids that I saw and Eric Bateman saw in his study was because people were taking it,” he said. “When they don’t take it, you don’t get the benefit from the drug.

“So I think in a real world setting, the benefits we would see with this approach might be even greater than the ones we see in the formal clinical trial setting.”

Both studies were funded by AstraZeneca. They will be presented May 20 at the American Thoracic Society conference in San Diego.