Topic

Anti-inflammatory reliever therapy

Alexander Wilkinson
Alexander Wilkinson • 27 April 2023
6 comments

Without much fanfare (yet), we now have a combination steroid + bronchodilator treatment licensed for use as needed in "mild" asthma. No maintenance therapy, just as needed, so it's not MART.

This has been part of GINA guidelines for some time, and widely recognised as a better way of treating asthma, but so far we've not had any licensed products.

https://ginasthma.org/pocket-guide-for-asthma-management-and-prevention/

The emerging popular name for this type of treatment is AIR, anti-inflammatory reliever therapy. It's important not just because it simplifies therapy for patients, reduces severe exacerbations, and is a cost-effective strategy. It also reduces carbon footprint massively (perhaps 30-fold) compared to the traditional blue + brown puffers, which the large majority of UK asthma patients are given.

https://erj.ersjournals.com/content/55/1/1901407.long

https://erj.ersjournals.com/content/60/suppl_66/4578

The license is for Symbicort 200/6 in patients over 12 with mild asthma.

https://www.medicines.org.uk/emc/product/1327/smpc

 

Comments (6)

Deborah Leese
Deborah Leese • 1 year ago

We are changing local guidance imminently to include the use of anti inflammatory reliever for 12 and over with symbicort 200/6. Totally agree that this has great potential in particular for those with infrequent symptoms who will not/do not use a regular ICS. My understanding is that we can't really call it AIR as apparently the term is already copyrighted in the UK for something else - this is what AZ told me anyway

Jacqueline Reynolds
Jacqueline Reynolds • 1 year ago

We are due to update our All Wales Asthma guidelines soon and want to include this, we just need to decide at what point you would step-up from PRN to MART / Fixed dose maintenance, the ERS paper is helpful (thankyou) but I'd be interested to hear what other areas are planning

Garry McDonald
Garry McDonald • 1 year ago

Dunno if you would step up from PRN to MART.

Maybe PRN if the patient is only using ONE inhaler. Start on ICS then ICS/LABA fixed, then MART if appropriate.

MART is the future though

Nuala Hampson
Nuala Hampson • 1 year ago

I read an article recently by Aarti Bansal which talked about the language we use around inhalers and the implications this might have for patients' understanding: "Some people think we should call preventer inhalers ‘treatment’ inhalers and reliever inhalers ‘rescue’ inhalers to help better communicate how they should be used."
I thought this was a really good way to subtly change the perception of how inhalers work. You can read the full article here https://humberandnorthyorkshire.org.uk/3799-2/

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