Implementation of the National Asthma Guidelines in New Zealand: a retrospective patient-level study of the change to anti-inflammatory reliever therapy in 324,972 patients
5 affiliations
- 1School of Pharmacy, The University of Auckland; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China
- 2School of Pharmacy, The University of Auckland
- 3Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia
- 4Alfred Hospital and Monash University, Melbourne, Australia
- 5School of Pharmacy, The University of Auckland; Corresponding author.
Abstract
Background: The updated New Zealand asthma guidelines in 2020, aligning with global asthma guideline recommendations, advocated for a fundamental shift from short-acting β2-agonist (SABA) reliever therapy to anti-inflammatory reliever (AIR) therapy (ICS-formoterol) in adults and adolescents. While aggregate population-level data indicate increased ICS-formoterol dispensings, patient-level changes in medication use remain unclear. We examined medication use patterns to assess early practice changes across the entire asthma population. Methods: We conducted a retrospective study using the New Zealand national linked health datasets. Patients aged ≥12 with asthma were identified from hospitalisation and/or dispensing data, and categorised by the complete set of inhaler classes dispensed in the three months preceding their final dispensing date within the baseline (July 2018–June 2020) and post-guideline (June 2020–June 2022) periods. Nine mutually exclusive categories were defined without applying any hierarchy between medications: SABA only; ICS, non-formoterol ICS-LABA, and ICS-formoterol, each with and without a concurrently dispensed SABA; other regimens; and no inhaled medication. Age subgroups (12–44 and ≥ 45 years) were examined. Children aged < 12 years throughout follow-up, who were outside the scope of the recommendation, served as a comparison cohort for difference-in-differences estimation. Findings: The cohort included 324,972 patients aged ≥12 years. At baseline, the SABA-only group was the most common (30.5%). Post-guideline, dispensing of the guideline-recommended regimen, ICS-formoterol without SABA, more than doubled from 10.9% to 23.8%, and any ICS-formoterol use rose from 18.9% to 34.5%. The proportion of patients dispensed any SABA fell from 74.1% to 60.8%. Of patients dispensed SABA only pre-guideline, 57.1% were dispensed SABA only again, while 17.6% changed to ICS-formoterol without SABA and 8.1% to ICS-formoterol with SABA. Continuity was high among patients on maintenance therapy (55.9% for ICS, 74.3% for non-formoterol ICS-LABA) and among those already dispensed ICS-formoterol (89.0%). Among post-guideline ICS-formoterol users, 31.1% were also dispensed a SABA, compared with 63.8% of non-formoterol ICS-LABA users and 70.2% of ICS users. Using children aged < 12 years as a comparison cohort, difference-in-differences estimates were +8.4 percentage points for ICS-formoterol without SABA and −8.3 percentage points for total SABA supply, but −0.2 percentage points for SABA monotherapy. Interpretation: The impact of the guideline change was substantial but selective. While the update facilitated transition for patients already receiving maintenance therapy, most patients on SABA-only regimens did not switch to the preferred AIR regimen. Further targeted implementation strategies beyond guideline publication are required to address this gap and ensure evidence-based care is consistently delivered. Funding: None.
Related
- Cost-effectiveness of anti-inflammatory reliever (AIR) or maintenance and reliever therapy (MART) for mild to moderate asthma: a systematic review.
- Compliance with guidelines for antibiotic therapy in infective endocarditis in older adults: a national-based real life retrospective cohort study
- Comparator choice in clinical trials of cancer drugs and recommendation categories in National Comprehensive Cancer Network (NCCN) guidelines: a retrospective cohort analysis
- Diagnostic performance, implementation fidelity, and costs of the World Health Organization three-test HIV testing strategy in Malawi: a national retrospective evaluation
- Adherence to French guidelines on cuff leak test use across French intensive care units: a national survey
BibTeX
@article{cheng2026implementation,
title = {{Implementation of the National Asthma Guidelines in New Zealand: a retrospective patient-level study of the change to anti-inflammatory reliever therapy in 324,972 patients}},
author = {Franco Wing Tak Cheng and Jiayi Gong and Andrew Tomlin and William Harrison and Kebede Beyene and Helen K. Reddel and Jeff Harrison and Mark Hew and Amy Hai Yan Chan},
journal = {The Lancet Regional Health. Western Pacific},
year = {2026},
month = oct,
doi = {10.1016/j.lanwpc.2026.102002},
url = {https://doi.org/10.1016/j.lanwpc.2026.102002},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Implementation of the National Asthma Guidelines in New Zealand: a retrospective patient-level study of the change to anti-inflammatory reliever therapy in 324,972 patients
AU - Franco Wing Tak Cheng
AU - Jiayi Gong
AU - Andrew Tomlin
AU - William Harrison
AU - Kebede Beyene
AU - Helen K. Reddel
AU - Jeff Harrison
AU - Mark Hew
AU - Amy Hai Yan Chan
PY - 2026
DA - 2026/10/01
JO - The Lancet Regional Health. Western Pacific
DO - 10.1016/j.lanwpc.2026.102002
UR - https://doi.org/10.1016/j.lanwpc.2026.102002
AB - Background: The updated New Zealand asthma guidelines in 2020, aligning with global asthma guideline recommendations, advocated for a fundamental shift from short-acting β2-agonist (SABA) reliever therapy to anti-inflammatory reliever (AIR) therapy (ICS-formoterol) in adults and adolescents. While aggregate population-level data indicate increased ICS-formoterol dispensings, patient-level changes in medication use remain unclear. We examined medication use patterns to assess early practice changes across the entire asthma population. Methods: We conducted a retrospective study using the New Zealand national linked health datasets. Patients aged ≥12 with asthma were identified from hospitalisation and/or dispensing data, and categorised by the complete set of inhaler classes dispensed in the three months preceding their final dispensing date within the baseline (July 2018–June 2020) and post-guideline (June 2020–June 2022) periods. Nine mutually exclusive categories were defined without applying any hierarchy between medications: SABA only; ICS, non-formoterol ICS-LABA, and ICS-formoterol, each with and without a concurrently dispensed SABA; other regimens; and no inhaled medication. Age subgroups (12–44 and ≥ 45 years) were examined. Children aged < 12 years throughout follow-up, who were outside the scope of the recommendation, served as a comparison cohort for difference-in-differences estimation. Findings: The cohort included 324,972 patients aged ≥12 years. At baseline, the SABA-only group was the most common (30.5%). Post-guideline, dispensing of the guideline-recommended regimen, ICS-formoterol without SABA, more than doubled from 10.9% to 23.8%, and any ICS-formoterol use rose from 18.9% to 34.5%. The proportion of patients dispensed any SABA fell from 74.1% to 60.8%. Of patients dispensed SABA only pre-guideline, 57.1% were dispensed SABA only again, while 17.6% changed to ICS-formoterol without SABA and 8.1% to ICS-formoterol with SABA. Continuity was high among patients on maintenance therapy (55.9% for ICS, 74.3% for non-formoterol ICS-LABA) and among those already dispensed ICS-formoterol (89.0%). Among post-guideline ICS-formoterol users, 31.1% were also dispensed a SABA, compared with 63.8% of non-formoterol ICS-LABA users and 70.2% of ICS users. Using children aged < 12 years as a comparison cohort, difference-in-differences estimates were +8.4 percentage points for ICS-formoterol without SABA and −8.3 percentage points for total SABA supply, but −0.2 percentage points for SABA monotherapy. Interpretation: The impact of the guideline change was substantial but selective. While the update facilitated transition for patients already receiving maintenance therapy, most patients on SABA-only regimens did not switch to the preferred AIR regimen. Further targeted implementation strategies beyond guideline publication are required to address this gap and ensure evidence-based care is consistently delivered. Funding: None.
SN - 2666-6065
ER -