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Research / Firestone Institute/ News/ St. Joe's Congratulates the Firestone Institute

Recognizing four papers that represent four breakthroughs in asthma research

Good things come in threes; great things come in fours. St. Joseph's Healthcare Hamilton congratulates researchers at the Firestone Institute for Respiratory Health on a rare and remarkable achievement - four publications in the New England Journal of Medicine, published only weeks apart. These papers represent significant advancements in the treatment of mild and severe asthma.

Discover the significance of each of these papers, and how they are transforming treatment of mild and severe asthma.


Dr. Parameswaran Nair (left), and Dr. Paul O'Byrne (right), authors of the papers; and Dr. Martin Kolb (seated), Firestone Research Director


Mild Asthma

What's in your asthma inhaler?

Dr. Paul O'Byrne's research on mild asthma medications will change how doctors prescribe medications such as Bricanyl® (terbutaline), Pulmicort® (budesonide), and Symbicort® (budesonide-formoterol).

Statistics Canada estimates that 8.1% of Canadians - roughly 2.4 million people - have been diagnosed with Asthma. Many of these patients will be using an outdated treatment model, one that ignores adherence rates and fails to treat the underlying inflammation that can lead to asthma exacerbations. Dr. O'Byrne's two papers, published in the same issue of the New England Journal of Medicine1, 2, demonstrate an effective alternative to as-needed terbutaline inhalers.

Read more about Dr. O'Byrne's international study and the specific findings here. 



Studies proves asthma medications safe - FDA removes "black box" warning

Dr. O'Byrne is an author of the most recent of these four papers published in the New England Journal of Medicine3, a monumental, international meta-analysis of four clinical trials.

A combined-drug used in mild asthma treatment has had its boxed warning (i.e. severe warning) lifted by the FDA in light of new research that demonstrated the drug's safety. The removal of a boxed warning is not common. However, due to “strong and consistent evidence" from the meta-analysis, the FDA felt it was no longer needed.

As well, these combined glucocorticoid-LABA drugs were shown to be 17% more effective in preventing asthma exacerbations compared to a glucocorticoid alone.

Read more about this international study of over 36,000 participants, and how clinical research has proven the safety of combined-drug asthma treatment.   



Severe Asthma

Reducing steroid doses in the treatment of severe asthma

Dr. Parameswaran Nair has made breakthroughs in treatments for severe asthma.

Like mild asthma, inhaled corticosteroids are typically prescribed to patients to control cases of severe asthma. However, in the higher doses that are needed to control severe asthma symptoms, these steroids can lead to a slew of serious side effects.

Fortunately, Nair's team found an alternative treatment that allowed patients to reduce their steroid doses by up to 70%. Nair's team found that an anti-body called Dupilumab could block specific protein signals that cause inflammation. The drastic reduction of inhaled corticosteroids lowers the risk of severe side effects typically associated with high steroid use.

Read more about Nair's latest study, published in the New England Journal of Medicine4. Dr. Nair presented these findings at the American Thoracic Society's international conference in San Diego in May.


 Dr. Nair, whose work with protein antibodies, such as Dupilumab, is helping patients with severe asthma to reduce their dependence on corticosteroids.



Recognizing Firestone

"My congratulations to Drs. O’Byrne and Nair on their four remarkable publications in the renowned New England Journal of Medicine. This unique feat is yet another example of the extraordinary performance of the Firestone Institute at St. Joe’s, and McMaster University.”

-Dr. Louis-Philippe Boulet

Université Laval & Chair of the Board of Directors,
Global Initiative for Asthma


"Each of these papers has worldwide direct impact on the care of patients with chronic lung disease – it is an outstanding achievement. This is evidence to our community that St Joseph’s is a hospital that delivers world quality compassionate care with both a heart and a brain.”

-Dr. Jack Gauldie

Vice President Research, St. Joseph's Healthcare Hamilton



Publication References

1. Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma

2. As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma

3. Combined Analysis of Asthma Safety Trials of Long-Acting Beta2-Agonists

4. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma