Asthma Treatment

Reducing the risk of asthma attacks is the number one priority for the management of asthma in New Zealand, and a major focus of the MRINZ Asthma programme.

Asthma is a chronic respiratory disease that affects over 610,000 New Zealanders, with New Zealand having one of the highest rates of asthma in the world — particularly in Māori and Pacific communities. There have been longstanding concerns that the traditional approach of using a short-acting beta-agonist (SABA) as reliever therapy in asthma may be associated with risk across the spectrum of asthma severity. These concerns have led to a novel treatment approach in which a ‘preventer’ inhaled corticosteroid is combined with a ‘reliever’ beta-agonist within the same inhaler device, which is used as-needed for relief of symptoms.

The idea behind the 2 in 1 combination reliever therapy approach is that it allows the patient to self-titrate the dose of the preventer medication according to their changing needs, and in particular, increases the dose of preventer during worsening asthma when the underlying airways inflammation is greater.

A series of large MRINZ-led, randomised controlled trials demonstrate that the budesonide/formoterol combination 2 in 1 inhaler, markedly reduces the risk of severe attacks compared with a traditional single SABA reliever.

These findings have been incorporated into New Zealand and international guidelines which now recommend that the 2 in 1 inhaler is used rather than a SABA reliever in the management of asthma across the range of asthma severity. This novel therapeutic approach has been considered the biggest paradigm change in the management of asthma in adults for decades. However, there remains a lack of evidence as to whether this treatment approach is also beneficial for children, so to respond to this limitation, the MRINZ is now undertaking two large clinical trials of the 2 in 1 inhaler regimen in children with asthma.

benefit of surgical left atrial appendage occlusion has now been proven. There is no question that when patients with atrial fibrillation who are at increased risk of stroke are undergoing heart surgery, they should also have their atrial appendage occluded during their surgery. The MRINZ team has been crucial to the generation of evidence which has led to a new paradigm for stroke prevention in atrial fibrillation patients worldwide.