New Zealand's higher education institutions have once again positioned the country at the forefront of global health innovation, with research from the Medical Research Institute of New Zealand (MRINZ) and affiliated universities driving a pivotal update to the world's leading asthma management guidelines. The Global Initiative for Asthma (GINA) 2026 Strategy Report now recommends that children aged 6-11 with mild asthma adopt the same anti-inflammatory reliever (AIR) therapy as adults, a shift directly influenced by groundbreaking studies led by Kiwi researchers. This change promises to slash severe asthma attacks by up to 45%, preventing countless hospitalisations and potentially saving young lives worldwide.

Asthma remains one of New Zealand's most pressing paediatric health challenges, affecting one in eight Kiwi children and leading to disproportionately high hospitalisation rates, particularly among Māori and Pacific communities. University-linked experts at MRINZ have pioneered evidence that challenges outdated reliever-only approaches, advocating instead for combination inhalers like budesonide-formoterol that tackle both symptoms and underlying airway inflammation simultaneously.

The Burden of Childhood Asthma in Aotearoa New Zealand

In Aotearoa, childhood asthma prevalence hovers around 20-25% for ages 2-14, with hospitalisation rates 1.5 times higher for Māori children and 2.4 times for Pacific children compared to others. Environmental factors like damp housing, second-hand smoke, and urban pollution exacerbate risks, while access to optimal care varies regionally. Recent Environmental Health Intelligence New Zealand data shows over 7,800 paediatric asthma hospitalisations in 2022 alone, underscoring the urgency for better management strategies rooted in robust research from local universities.

Higher education plays a crucial role here, with institutions like the University of Otago and University of Auckland contributing longitudinal data through initiatives like the Global Asthma Network (GAN), originally stemming from the International Study of Asthma and Allergies in Childhood (ISAAC) at Auckland. These efforts have illuminated ethnic disparities and informed national guidelines, setting the stage for global influence.

From Adult Trials to Paediatric Breakthrough: MRINZ's Decade of Innovation

The journey began over a decade ago with MRINZ's Novel START trial in 2019, published in the New England Journal of Medicine, which demonstrated that as-needed budesonide-formoterol reduced severe exacerbations by 64% in mild asthma adults compared to salbutamol alone. Follow-up studies like SINGLE and SYGMA expanded this, solidifying AIR therapy's superiority.

Building on this, MRINZ—closely partnered with the University of Otago's Department of Medicine and Victoria University of Wellington—extended research to adolescents and now children via the Children's Anti-inflammatory Reliever (CARE) study. Published in The Lancet on September 27, 2025, CARE was a 52-week randomised controlled trial involving 360 children aged 5-15 across 15 New Zealand sites. Full study details here.

Decoding the CARE Study: 45% Fewer Attacks in Kiwi Children

CARE compared as-needed low-dose budesonide-formoterol (100/6 mcg metered dose, two actuations) against standard salbutamol reliever in mild asthma children previously on SABA monotherapy. The primary outcome—annualised moderate-to-severe exacerbations—dropped dramatically: 0.23 per participant-year in the combination group versus 0.41 in salbutamol (relative rate 0.55, 95% CI 0.35-0.86, p=0.012), equating to a 45% reduction.

Key subgroups benefited most: adolescents (12-15), males, and those with elevated fractional exhaled nitric oxide (FeNO), a marker of inflammation. No differences in growth velocity, lung function, or serious adverse events emerged, affirming safety. Led by first author Dr. Lee Hatter and senior author Professor Richard Beasley (MRINZ Director and Adjunct Professor at University of Otago), the trial's authors hailed from University of Auckland's Departments of General Practice, Paediatrics, and Starship Children's Hospital, alongside Otago University Wellington and Victoria University Wellington's School of Biological Sciences.

GINA 2026 Adopts NZ Evidence: A Paradigm Shift for Paediatric Care

The GINA 2026 report explicitly cites CARE, recommending AIR therapy (ICS-formoterol as reliever) at Steps 1-2 for children 6-11 with mild asthma—preferred for infrequent symptoms (≤2 days/week). This marks the first alignment of paediatric and adult strategies, ditching SABA monotherapy due to risks of death and urgent care (Evidence A). Access GINA 2026 full report.

Alternatives like as-needed low-dose ICS + SABA (from TREXA and ASIST trials) are noted, but AIR offers lower ICS exposure with comparable efficacy. For Steps 3-4, maintenance-and-reliever therapy (MART) with ICS-formoterol is evidence-based (Evidence B). This evolution, propelled by NZ data, simplifies regimens—no stepwise escalations as kids age—and prioritises inflammation control from diagnosis.

Photo by Museum of New Zealand Te Papa Tongarewa on Unsplash

University of Otago's Pivotal Role in Respiratory Excellence

The University of Otago stands out, with Professor Richard Beasley holding an adjunct professorship at its Wellington campus and Professor Bob Hancox, Foundation Medical Director, based in the Dunedin School of Medicine's Department of Preventive and Social Medicine. Hancox's epidemiological work on asthma trajectories via the Dunedin Multidisciplinary Health and Development Study complements MRINZ trials, providing real-world context.

Otago's legacy includes GAN coordination and national guideline contributions, fostering a research ecosystem where clinical trials translate to policy. "The evidence means we can start most children on the best treatment straight away," notes Hancox, underscoring how university expertise bridges lab to lives saved.

University of Auckland and Victoria University: Multidisciplinary Contributions

University of Auckland researchers, including from Paediatrics and Primary Care, co-authored CARE, leveraging ISAAC/GAN data on NZ's high prevalence. Victoria University of Wellington's biological sciences input ensured rigorous trial design. These collaborations exemplify NZ higher ed's strength in interdisciplinary health research, supported by Health Research Council funding.

Broader impacts: MRINZ trials correlated with NZ's 17% asthma admission drop (2019-2022), 32% for Māori—108% rise in combination inhaler use. Globally, this could avert millions of attacks annually.

Expert Perspectives: Quotes from the Frontlines

Letitia Harding, CEO Asthma and Respiratory Foundation NZ: "This new approach addresses both symptoms and inflammation—that’s what will save lives and prevent hospitalisations."

Professor Beasley: "Implementing these findings could be transformative for asthma management in children worldwide."

Such voices from uni-affiliated experts highlight the human stakes, with NZ's equitable access push vital for high-risk groups.

Challenges and Future Directions in NZ Higher Ed Research

Despite gains, inequities persist: Pacific children face 2.4x hospitalisation risk. Universities must scale culturally responsive trials, integrating Māori knowledge systems. Funding for MRINZ-Otago-Auckland hubs is key, amid global competition.

Future: Extending AIR to under-6s, digital monitoring (smart inhalers), and climate-asthma links. NZ unis' global clout positions them to lead.

Implications for Global Child Health and NZ's Research Legacy

GINA's adoption amplifies NZ's voice—Foundation as NGO rep ensures Aotearoa input. Reduced attacks mean fewer school absences, better quality of life. For higher ed, it showcases research's societal ROI, attracting talent to Otago, Auckland, Wellington.

Photo by Alexandre Lecocq on Unsplash

Actionable Insights for Parents, Clinicians, and Researchers

• Switch to AIR for mild paediatric asthma: Discuss budesonide-formoterol with GPs.
• Monitor FeNO for inflammation-guided care.
• Advocacy: Support uni research funding for equity-focused trials.
• Prevention: Tackle housing dampness, smoke exposure.

NZ higher ed's asthma odyssey exemplifies evidence-to-policy triumph, promising healthier futures.