Adult Asthma Patients Reduce Steroid Exposure And Improve Control With New Stepwise Approach

A new study undertaken by the Medical Research Institute of New Zealand (MRINZ) shows that adults with asthma can safely simplify their treatment, reduce overall steroid exposure and improve asthma control using a structured, stepwise Anti-Inflammatory Reliever (AIR) Algorithm.

Published in The Lancet's eClinicalMedicine, the 52-week open-label trial involved 100 adults aged 18–75 with mild, moderate or severe asthma. Participants started anti-inflammatory reliever therapy with the combination 2-in-1 budesonide-formoterol inhaler at one of three treatment steps, according to the severity of their asthma. They then followed a practical stepwise algorithm, in which their individual treatment was adjusted up and down the steps in response to reliever use and asthma attacks. Patients were guided in the use of the algorithm by doctors in the first half of the trial, and then adjusted their treatment steps themselves in the second half.

This practical stepwise approach to asthma management resulted in a clinically important increase in patient satisfaction. By the end of the trial, 60% of participants had transitioned to the lowest treatment step, using budesonide–formoterol solely as needed, compared with 25% who started the trial at this step. This meant that there was a marked reduction in overall exposure to inhaled steroids, highlighting the safety benefits of this approach. Despite this down-titration, there was a significant improvement in asthma symptom control and quality of life, and no deterioration in lung function.

“Our findings show that a stepwise anti-inflammatory reliever strategy allows adults to take control of their asthma simply and safely. It works across a wide range of asthma severities and improves asthma control and quality of life, while decreasing the risk of side effects from medication,” says Dr Pepa Bruce, lead author.

The study also provided important insights into the patients’ perceptions of AIR algorithm approach. During the trial, patients grew more confident in AIR therapy with budesonide-formoterol reliever and had fewer concerns about it. Most felt it worked better than their previous treatment, highlighting that it’s easy to use and likely to encourage consistent adherence.

Professor Richard Beasley, MRINZ Director, comments, “AIR therapy with budesonide-formoterol reliever has been shown to reduce the risk of asthma attacks compared with the traditional salbutamol reliever at every treatment step. What this study adds is that patients taking budesonide-formoterol can move between steps using a simple algorithm as their asthma severity changes. The AIR approach empowers patients to self-manage and gives clinicians a real-world, evidence-based pathway for safer asthma care.”

Andrew Craig, who participated in the clinical trial said “The protocol was easy to follow, and gave me confidence that I could self-manage my treatment, adjusting up and down as needed. The benefits of following the algorithm were apparent when my asthma severity increased slightly following my first bout of COVID. I was able to adjust my dose and get back under control, and having guidelines about when to seek GP advice gave me peace of mind. My asthma went from being something I always had in the back of my mind to something I rarely have to think about.”

“For years we have been telling people how much asthma medication to take and when to take it. This study shows that if we give people an anti-inflammatory reliever inhaler and the right advice, people can adjust how much they need according to their symptoms. They end up needing less medication overall, have better asthma control, and a better quality of life,” says Professor Bob Hancox (University of Otago and Medical Director of the Asthma and Respiratory Foundation) who was not involved in the study.

The AIR Algorithm study was funded with support from the Health Research Council of New Zealand and AstraZeneca. It represents the latest in a series of five landmark studies studying the efficacy and safety of the budesonide-formoterol reliever therapy-based treatments in children, adolescents and adults.

An anti-inflammatory reliever algorithm approach to asthma management in adults: an open-label, single-arm trial is published in The Lancet eClinicalMedicine https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00503-6/fulltext
 

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