MRINZ explores ground-breaking way of treating asthma

Dr Pepa Bruce, MRINZ clinical research fellow, Graeme Hansen, AIR therapy study volunteer, and Professor Richard Beasley, MRINZ director Photo: Rob Sarkies.

A new ‘AIR Algorithm Study’ of 100 New Zealand volunteers, led by the Medical Research Institute of New Zealand (MRINZ) in Wellington, is looking deeper into the implementation of AIR therapy, across the spectrum of mild to severe asthma, using just one combination inhaler for both regular scheduled maintenance and as-needed reliever use.

MRINZ has dedicated much of its research focus over the last two decades to the prevention and management of asthma, both here at home in Aotearoa New Zealand and around the world.

MRINZ’s asthma research has included three landmark studies which have shown that a 2 in 1 inhaler, containing both a preventer and reliever medication, is far more effective than the traditional single reliever inhaler, which has been the basis of asthma management for over 60 years.

These MRINZ studies have shown that the as-needed use of the combined 2 in 1 inhaler, referred to as ‘Anti-Inflammatory Reliever’ (AIR) therapy, markedly cuts the risk of severe asthma attacks when compared to the traditional single reliever.

"AIR therapy is considered the biggest paradigm advance in the management of asthma for decades. We are encouraged to see a major shift in clinical practice in New Zealand and internationally with the progressive uptake of AIR therapy. This evidence-based practice change will undoubtedly improve the quality of life of patients with asthma and reduce the global burden of this disease,” says Professor Richard Beasley, Director of the MRINZ.

Based on this knowledge, the Asthma and Respiratory Foundation NZ has recommended the use of AIR therapy as the preferred reliever treatment across the range of asthma severity with a simplified four step treatment regimen. International guidelines have recently followed suit with similar recommendations made by the Global Initiative for Asthma (GINA), coinciding with New Zealand’s inaugural New Zealand Asthma Awareness Day - Aotearoa Te Rā Whakaarohia te Huangō on May 2, 2021. This is a significant acknowledgement of the collective work of the New Zealand asthma research community.

Professor Beasley says, “What we now need to know is how patients should optimally vary their use of this 2 in 1 inhaler, in response to changes in the severity of their asthma over time. Having provided the evidence of the combined inhaler’s benefit and safety, this is now our next research priority.”

Volunteer clinical trial participation from members of the community is essential to the work that MRINZ undertakes. Graeme Hansen has generously volunteered twice for MRINZ Asthma Research, first with the PRACTICAL study, and now this latest AIR therapy study.

Graeme says, “I’m very grateful to the MRINZ for the public health research they undertake. I've loved working with the bright people there to make a difference in the world. My grandson has asthma too and knowing that these study outcomes will impact the ways in which we manage asthma for future generations is a meaningful and tangible legacy.”

Dr Pepa Bruce, MRINZ Clinical Research Fellow says, “This study is the first to explore how people can move between different steps of AIR therapy. As such, it should provide an extremely important piece of the evidence needed to empower people with asthma to take greater control of their own treatment, making sure it is always tailored to their individual needs.”

Depending on the severity of their asthma, each volunteer will be given a tailored ‘treatment step’ at the beginning of the study. As the study progresses, this treatment step will be reviewed and changed based on asthma symptoms. By the end of the year-long study, all 100 volunteers will be trained to monitor their own asthma symptoms and to use this as a guide to adjust their own asthma treatment.

This research encourages a patient-led approach to asthma management, supporting GP’s and specialists as they work directly with patients to best control their asthma across a spectrum of conditions.

Graeme says, “For me, MRINZ Asthma research participation is very much a two-way street. I know I’m helping a wonderful cause — and improving my own asthma health and understanding while doing it.”

More information

Around 5-10% of people worldwide suffer from asthma. Here in New Zealand, where our asthma statistics rank among the highest in the world, 1 in 8 adults need to take medications to help manage the symptoms of asthma, such as feeling wheezy or short of breath.

Traditionally, when people with asthma notice their symptoms, they use a type of inhaler known as a ‘bronchodilator,’ examples of which include Ventolin and Bricanyl. Whilst these medications open the airways and relieve symptoms, they do not treat the underlying inflammation which causes asthma.

In recent years, evidence from collective asthma research has supported the use of an inhaler called Symbicort. Symbicort is an inhaler which brings together two treatments in one process, using a bronchodilator to open the airways, and adding a steroid which acts to reduce and calm active airway inflammation, the underlying disease process in asthma. Because this combined inhaler can be used both to relieve asthma symptoms and to tackle the underlying inflammation that causes asthma, it is known as an Anti-Inflammatory Reliever (AIR) therapy.