A groundbreaking New Zealand asthma study using innovative local technology has found combination inhalers are more effective at preventing asthma attacks than the two inhalers doctors usually prescribe.
The prestigious Lancet medical journal, which published the research this week, said the compelling new evidence could change international asthma treatment practices and guidelines.
Current medical guidelines recommend adult patients are prescribed two inhalers - a regular-use preventive inhaler, and a reliever which is used to treat asthma symptoms.
But the Medical Research Institute study found a single inhaler, combining long-acting beta agonists from preventers with corticosteroids from relievers, was more effective at reducing severe asthma attacks.
Researchers used inhalers fitted with electronic monitoring chips, developed by Auckland medical technology company Nexus6, to compare the use of so-called smart inhalers with conventional inhalers among some 300 adult asthma patients in New Zealand.
The chips recorded data every time an inhaler was used, which enabled researchers to track patterns of use and delays in seeking treatment.
They found smart inhalers reduced the risk of severe asthma attacks without increasing the risk of beta agonist overuse or long-term corticosteroid exposure.
The amount of high use, marked overuse and extreme overuse of beta agonists was about 40 per cent lower among combination inhaler users than the group given the standard treatment.
While smart inhaler users had greater average daily exposure to corticosteroids, they had similar overall exposure because of a reduction is severe asthma attacks.
Researchers also found using smart inhalers did not lead to a greater delay in seeking medical help for a severe asthma attack - a common contributing factor to the risk of fatal attacks.
Medical Research Institute director Professor Richard Beasley, a respiratory medicine expert at Otago University in Wellington, said the smart inhaler regime was already in use in New Zealand, but the study gave further confirmation of its effectiveness.
"We've been able to look at the efficacy and safety in so much more detail because we did the electronic monitoring.
"We've got an insight and a knowledge of the regime greater than anyone else has been able to achieve before. And as the Lancet editorial says, this will change practice and guidelines.''
Dr Beasley said patterns of use and delays in seeking treatment had not really been addressed in previous studies, which had bolstered interest in his team's study.
"The novel nature of the monitoring means we can actually explore the safety and the benefits of the different regimes in more detail.''
The chips could be used by GPs to track individual patient use in the future, but Dr Beasley said monitoring could be difficult to establish in clinical practice and the benefits were yet to be assessed.
He said smart inhalers were not suitable for all patients and were restricted to those with moderate to severe asthma.
The study, funded by the Health Research Council, is the first of its kind without sponsorship from a pharmaceutical company.
The 24-week trial involved 303 patients, aged 16 to 65, who were recruited from hospitals and primary care clinics in the Auckland, Tauranga and Wellington areas.
The study was published in The Lancet's newly launched Lancet Respiratory Medicine journal, along with a European study which also tracked smart inhaler use.
The journal said the findings of both studies challenged national and international medical guidelines, particularly in the United States, where combination inhalers were yet to be approved.
WHAT IS THE NEXUS6 SMART INHALER?
* The Nexus6 is a commercially available asthma inhaler which electronically monitors usage
* A microprocessor built into the inhaler records data every time a patient takes a puff
* Data is wirelessly transmitted via the internet or mobile phone
* Patients, doctors and researchers can monitor the frequency of doses in real-time
* It was developed and made by Auckland company Nexus6, which was founded by asthma sufferer Garth Sutherland
* The company has a distribution contract in Europe and a software deal with the US Food and Drug Administration