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News & Trends - Pharmaceuticals

Asthma experts push for greater uptake of step-down treatment approach

Health Industry Hub | August 5, 2022 |
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Pharma News: Seven (7) out of ten (10) Australians with asthma aged over 12 years may be prescribed too much preventer medicine.

Prof Helen Reddel, Chair of the Science Committee of the Global Initiative for Asthma (GINA) and a member of the Guidelines Committee for the Australian Asthma Handbook, and co-authors from the Woolcock Institute of Medical Research recommend finding the lowest effective dose to control asthma.

The 2021 Census highlights that over 2 million Australians have asthma. It is one of the three most common long-term health conditions in Australia.

“There are lots of reasons why you may be using a higher dose of asthma preventer medicine than you need,” said Prof Reddel.

“If your asthma has been stable for more than three months, check with your doctor. It may be possible to reduce the dose.”

According to Prof Reddel, a step-down option available in Australia since 2020 is to switch to AstraZeneca’s Symbicort, an as-needed combination of low-dose budesonide with formoterol.

The patient uses the low-dose Symbicort inhaler whenever needed for symptom relief, instead of a short-acting β2-agonists (SABA). This option is supported by three large studies, including the SYGMA 1 and 2 studies in mild asthma, that showed symptom control and lung function were similar, and the risk of severe exacerbations was the same or lower, compared with continuing regular daily inhaled corticosteroids (ICS) with as-needed SABA. Importantly, the risk of severe exacerbations was reduced by more than 60% compared with switching to SABA-only treatment. 

Patients took an average of three to four doses of budesonide/formoterol 200/6 micrograms per week. In clinical practice, one inhaler would last an average of six months. Although the initial out-of-pocket cost to the patient would be higher, the average daily cost to the patient over the life of the inhaler would be much lower than with daily ICS or daily ICS–LABA, plus an as-needed SABA.

“With asthma, it is not a case of ‘one size fits all’,” said Prof Reddel.

“The medicines and doses needed are personalised for each patient. Providing this [step-down] treatment is still preventing asthma flare-ups. It can also lower the chance of uncommon side effects like cataracts and brittle bones.”

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