More than 20 million American adults have asthma, according to the Centers for Disease Control and Prevention. This chronic condition can make breathing difficult and cause symptoms like coughing, wheezing and shortness of breath. Asthma can range from mild to severe, depending on how often symptoms occur. People with moderate to severe asthma have symptoms every day or several times a day, but symptoms can occur less often if their asthma is well managed.
One of the most common ways to control asthma is by using a daily inhaler that contains an inhaled corticosteroid — a “controller” medicine that helps prevent symptoms. In addition, when having an asthma attack, people use a fast acting “reliever” medicine through an inhaler or a nebulizer.
However, many people don’t like taking daily medication, especially if their symptoms come and go. Elliot Israel, M.D., the principal investigator of the the PREPARE study, a patient-centered comparative clinical effectiveness research (CER) study funded by PCORI, explains that asthma isn’t always a daily problem. One week someone might have an attack and the next, feel fine — making daily treatment feel unnecessary to some. To address this concern, the PREPARE study tested a different approach to asthma management.
Research for the Real World
Instead of taking a daily dose of controller medicine, participants in the PREPARE study took one dose of their controller medication only when they used their reliever. This method aimed to better match treatment with the times when symptoms actually occurred. Drawing on the lived experience of people with asthma, their caregivers and clinicians, Israel and the research team designed the study to prioritize what matters most to adults living with asthma: minimizing missed days at work or school, being able to care for family and maintaining income. This offered a more flexible way to control asthma that fits more naturally into daily life.
One of the most important pieces of the puzzle in making this study such a success was its design as a pragmatic clinical trial. Unlike traditional clinical trials, which often take place under controlled conditions, pragmatic trials are designed to reflect real-world settings and experiences. This means the results are more likely to apply to a broader range of people.
Israel explains that the strength of the PREPARE study lies in its inclusive approach. By involving people with asthma across a broad spectrum of symptom severity, life circumstances and personal challenges, the study produced evidence that this flexible treatment approach can work for many individuals, not just a select few.
Results That Matter
After 15 months of the study, the treatment group who utilized the new care routine had better rates of asthma control, fewer asthma attacks, better quality of life and fewer missed days of work or school compared to participants who continued receiving their usual standard asthma care.
Posted: July 31, 2025