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(Scroll to the bottom for an infographic outlining the study findings.)

Editor’s note: this article uses trade names to ease reading. This includes Bricanyl® (terbutaline), Pulmicort® (budesonide), and Symbicort® (budesonide/formoterol). See the label on your inhaler for its medicinal components.

New research from the Firestone Institute for Respiratory Health at St. Joseph’s Healthcare Hamilton has shown that Bricanyl (terbutaline), a commonly prescribed inhaler used as-needed to treat asthma symptoms, is inferior to other medicines for managing asthma. The year-long study of nearly four thousand participants found that, when used as-needed, Symbicort (budesonide-formoterol) inhalers were superior to Bricanyl in improving long-term asthma control and in reducing the risk of asthma exacerbations.

Researchers have also shown that the best long-term asthma control is achieved with the use of the maintenance drug Pulmicort (budesonide), which is usually taken twice daily regardless of symptoms. Maintenance drugs work by administering an inhaled steroid to control asthma inflammation.

Dr. Paul O’Byrne, a researcher at the Firestone Institute and Dean of the Faculty of Health Sciences at McMaster University, is the first author of this game-changing study. The results were published in the May 17 edition of the New England Journal of Medicine, and are expected to significantly impact how doctors prescribe medications to asthma sufferers in Canada and around the world.

The study focused on how people were using (or not using) their asthma medications, including as-needed and maintenance inhalers. Poor adherence to a maintenance drug is one of the main factors that can lead to an increased risk of asthma exacerbation. This is due to the lack of treatment towards underlying inflammation.

“People will take their inhalers when they need them, but there is an enormous problem with adherence to a regular preventative schedule when patients are feeling well, which in mild asthma is most of the time.” said Dr. O’Byrne. “We’ve found that replacing as-needed Bricanyl inhalers with Symbicort drastically reduced the risk of asthma exacerbation, without having to rely on a maintenance drug.”

These findings are significant because many mild asthma sufferers experience a severe exacerbation that requires emergency care at some point in their lives. Symbicort contains a small dose of budesonide that helps control exacerbations, which patients might not otherwise receive due to the low adherence rates of maintenance drugs.

Steroid-based maintenance drugs like Pulmicort are still considered to be superior to as-needed Symbicort when it comes to long-term asthma control. However, concerns about possible side effects from inhaled steroids are a major cause of poor drug adherence. Because less than one-fifth the steroid dose was administered with as-needed Symbicort, the concerns that patients may have about possible side effects are reduced.

Dr. O’Byrne is presenting these findings at the American Thoracic Society’s International Conference in San Diego, which runs May 17 – 23, 2018.


Innovative Research Tech

Researchers used digital inhaler monitors among study participants to make accurate inhaler usage logs, which proved to be a major strength of the study. The Smartinhaler™ platform, designed and manufactured by Adherium, interfaces with the cloud to log inhaler usage and can send reminders for patients to take their medication. The technology was conceived in order to improve patient adherence to treatment programs, particularly with children.

Adherium is a great example of how innovators are using technology to benefit overall patient health,” said Dr. Gail Martin, Executive Director of the Research Institute of St. Joe’s. “We have devices to log our exercise, track our bodyweight, etc. In the future, doctors won’t need to ask ‘have you been taking your meds?’ – they’ll be able to see for themselves.”



“When it comes to respiratory healthcare, all roads lead to Firestone,” said Dr. Martin Kolb, Research Director at the Firestone Institute in Hamilton. He noted that “groundbreaking studies of this magnitude helped put Hamilton on the map for respiratory health, and our researchers are still making waves today.”

The Research Institute of St. Joe’s Hamilton oversees the work of over two hundred researchers and their teams, including research conducted at the Firestone Institute for Respiratory Health. 


An infographic detailing the research findings about asthma, budesonide, terbutaline, budesonide-formoterol

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