A groundbreaking research initiative led by the University of Auckland is transforming asthma management in New Zealand, particularly for Māori and Pasifika communities disproportionately affected by the condition. The world-first study, centred in the Waikato region, employs point-of-care testing to guide personalised treatment during asthma attacks, aiming to drastically cut reliance on oral corticosteroids—powerful drugs long associated with serious side effects.
Asthma affects around 15 percent of New Zealand children and 10 percent of adults, with hospital admissions and emergency visits remaining stubbornly high. Māori have asthma hospitalisation rates three times higher than non-Māori, while Pasifika peoples face even steeper inequities, often enduring more severe attacks and repeated courses of steroids. These disparities highlight a critical need for tailored approaches that address both clinical and cultural contexts.
The project introduces biomarker-guided therapy right at the primary care level. Traditional protocols prescribe a fixed burst of oral corticosteroids, or OCS, for every asthma exacerbation, regardless of the underlying inflammation type. This one-size-fits-all method exposes many patients to unnecessary risks like osteoporosis, diabetes, adrenal suppression, and weight gain, especially vulnerable groups who may require frequent dosing over years.
Understanding Point-of-Care Testing in Asthma Care
At the heart of this University of Auckland-led trial is point-of-care testing, or POCT, a rapid diagnostic tool performed bedside or in-clinic without lab delays. Specifically, it measures fractional exhaled nitric oxide, or FeNO—a non-invasive breath test detecting eosinophilic airway inflammation, the type that responds best to steroids.
The process unfolds step-by-step: During an asthma attack, patients blow into a handheld FeNO device, yielding results in minutes. Low FeNO suggests non-inflammatory triggers, sparing steroids and opting for alternatives like increased inhaled therapies or bronchodilators. High FeNO confirms steroid-responsive inflammation, ensuring precise dosing. This precision medicine shift promises safer, more effective care, potentially halving steroid courses lifetime.
The Research Team and University of Auckland's Role
Associate Professor Amy Chan from the University of Auckland's School of Pharmacy heads the effort, collaborating with experts like Associate Professor Anneka Anderson, Dr Christina Baggott, and Professor Paige Lacy. Hosted by New Zealand's premier medical school, the trial leverages Auckland's strengths in pharmacy-led innovations and health equity research.
Waikato primary care sites serve as trial hubs, bridging urban Hamilton clinics with rural practices to reach high-need Māori and Pasifika whānau. Consumer advisors ensure cultural safety, incorporating tikanga Māori into recruitment and follow-up. Funded by a $1.4 million Health Research Council grant over 36 months starting 2025, it underscores universities' pivotal role in translating lab insights to community impact.
The University of Auckland's track record in respiratory research amplifies this work. Past studies on inhaler adherence and mild asthma therapies have shaped global guidelines, positioning NZ universities as leaders in equitable health solutions.
Asthma Disparities: Why Māori and Pasifika Need Targeted Interventions
Māori children face asthma prevalence double the national average, with Pasifika rates similarly elevated. Factors include housing dampness, tobacco exposure, and barriers to preventive care. Hospital data reveals Māori comprise 20 percent of paediatric admissions despite being 15 percent of the population.
Steroid overprescription exacerbates inequities; repeated OCS bursts compound metabolic risks in communities already grappling with higher diabetes burdens. This trial's focus on primary care—where 80 percent of attacks first present—empowers GPs and whānau health workers with tools for immediate, culturally attuned decisions.
- Higher attack frequency among Māori/Pasifika due to socioeconomic determinants
- Limited access to specialists, relying on OCS as default
- Cultural mistrust of pharmaceuticals, underscoring need for evidence-based personalisation
Trial Design: Rigorous Science for Real-World Change
Participants, aged 16-65 with acute asthma symptoms, undergo stratified randomisation: POCT-guided arm versus standard OCS. Follow-up tracks OCS days, treatment failures (re-presentations within 7 days), asthma control via ACT scores, quality-of-life metrics, adverse events, and cost savings.
Expected enrolment: 300 across Waikato sites, powered to detect 30 percent OCS reduction. Interim analyses ensure safety, with health economics modelling long-term benefits like fewer ED visits—costing NZ$500 million annually nationwide.
This pragmatic design mirrors everyday practice, enhancing guideline adoption post-trial. Learn more about the funded project.
Risks of Oral Corticosteroids: Beyond Short-Term Relief
Oral corticosteroids like prednisone provide rapid attack control but at a cost. Short bursts risk gastrointestinal upset; cumulative exposure heightens osteoporosis (30 percent fracture risk increase), cataracts, and infections. In NZ, 40 percent of severe asthmatics receive frequent OCS, driving $100 million yearly healthcare spend.
POCT mitigates this by identifying steroid-non-responders early, favouring inhaled options or biologics. For Māori whānau, avoiding intergenerational metabolic harm aligns with holistic wellbeing.
Broader Implications for New Zealand Healthcare
Success could redefine national guidelines, embedding POCT in GP toolkit nationwide. Cost savings—FeNO devices ~$2000, tests $20—pale against OCS complications' burden. Scalability to telehealth extends reach to remote iwi.
University of Auckland's pharmacy integration exemplifies interdisciplinary prowess, training future clinicians in precision respiratory care. Partnerships with Waikato DHB foster regional innovation hubs.
Stakeholder Perspectives and Early Feedback
Dr Christina Baggott notes, "Personalised pathways address inequities head-on, empowering communities." Pasifika health leaders praise cultural embedding, while GPs anticipate workflow efficiency.
Preliminary FeNO audits in Waikato clinics show 40 percent low-inflammation attacks, hinting at steroid avoidance potential. Patient surveys emphasise trust in data-driven care over blanket prescriptions.
Future Outlook: From Waikato to Global Impact
Launching 2025, results by 2028 could influence GINA guidelines. University of Auckland eyes expansions to paediatrics and COPD. Amid rising respiratory burdens from climate change, such uni-driven trials position NZ as innovator.
For aspiring researchers, opportunities abound in higher ed research roles. Explore careers advancing health equity at NZ universities.
This Waikato study exemplifies how academic excellence tackles pressing needs, promising healthier lungs and lives.