Too Few Asthma Patients Are Using Updated Inhalers

WEDNESDAY, May 22, 2024 (HealthDay News) -- Improved inhalers are now available to help control asthma and treat sudden attacks, but a new study shows that hardly anyone’s using them.

The new inhalers combine inflammation-fighting corticosteroids with a long-acting drug called formoterol that opens up the airways, researchers report.

These combo inhalers are used twice a day to treat moderate to severe asthma, and they can also be used as a rescue inhaler during an asthma attack.

Guidelines from both the National Asthma Education and Prevention Program and the Global Initiative for Asthma now recommend the use of what are called “SMART” inhalers.

But fewer than 1 in 6 adults with moderate or severe asthma have been prescribed a SMART inhaler, and more than 2 of 5 lung and allergy specialists haven’t adopted the combo therapy, researchers found.

“Our findings suggest current asthma management guidelines are not being routinely implemented or adopted by clinicians,” said senior study author Dr. Sandra Zaeh, a pulmonary and critical care medicine physician at Yale University School of Medicine.

Previous guidelines have recommended the use of maintenance inhalers twice a day, in addition to a short-acting rescue inhaler containing a drug like albuterol that opens airways, researchers said.

By 2021, U.S. guidelines had been updated to recommend Single combination corticosteroid and formoterol inhaler for both Maintenance And Relief Therapy (SMART).

SMART inhalers available in the United States include Symbicort (budesonide-formoterol) and Dulera (mometasone-formoterol), researchers said.

The SMART approach has been shown to significantly reduce asthma symptoms and attacks, compared to traditional therapy using two separate inhalers, researchers noted.

To see whether the guidelines had been adopted by doctors, researchers searched electronic medical records to identify asthma patients who’d been prescribed an inhaler by a doctor at a lung or allergy clinic between January 2021 and August 2023.

More than 2,000 patients were included in the final analysis, of whom uless than 15% had been prescribed the recommended SMART combo inhaler, researchers found.

Further, more than 40% of doctors hadn’t adopted the therapy for their patients’ use, results show -- even though an earlier study found that 93% of lung doctors are aware of the updated guidelines.

Even when a SMART inhaler was prescribed, 87% of those patients were also prescribed a rescue inhaler even though one isn’t needed, researchers found.

Older patients and those insured by Medicare were less likely to be given a SMART prescription, researchers noted.

“Providers are less likely to try a new inhaler regimen with older individuals or seniors who are more resistant to changing treatment regimens, especially if they have been using the same inhalers for years,” said lead researcher Zoe Zimmerman, a medical student and researcher with the Yale's School of Medicine.

The findings were presented Tuesday at the American Thoracic Society’s annual meeting in San Diego. Such research is considered preliminary until published in a peer-reviewed journal.

Past studies have noted it can take more than 15 years for guidelines to be widely adopted by doctors of any stripe, the researchers acknowledged.

“Our findings reinforce the idea that adoption of guidelines by clinicians takes time,” Zeah said in a meeting news release.

More information

The Allergy & Asthma Network has more on SMART therapy for asthma.

SOURCE: American Thoracic Society, news release, May 21, 2024