Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study shows symptom-driven therapy may be ok for some adults with mild persistent asthma

14.04.2005


Some adults with mild persistent asthma may be able to adequately control their asthma by taking corticosteroids only when needed, instead of taking anti-inflammatory medication daily, according to new results from the Improving Asthma Control Trial (IMPACT). Conducted by the National Heart, Lung, and Blood Institute’s (NHLBI) Asthma Clinical Research Network, the one-year, multi-center study found that participants who were treated with corticosteroids intermittently based on symptoms had about the same rate of severe exacerbations and of asthma-related lung function decline as those treated with the standard recommendation of daily long-term control medication.



Asthma is considered mild and persistent when individuals have acute symptoms such as wheezing, coughing, or chest tightness more than twice a week, but not daily, or they have night-time awakenings due to asthma more than two nights a month. The researchers caution that the new findings might not apply to people who have recently developed asthma. In addition, they do not apply to patients with more frequent symptoms or more severe asthma. The results are published in the April 14 issue of the New England Journal of Medicine.

"This study provides evidence of another possible way to treat adults with long-standing mild persistent asthma," stated Elizabeth G. Nabel, MD, director of the NHLBI, part of the National Institutes of Health. "If additional research confirms these findings, then some of these patients may be able to safely treat their asthma with intermittent medication and avoid the added expense and inconvenience of daily therapy. As for all asthma patients, however, individuals should work closely with their healthcare providers to develop and follow the treatment plan that suits them best."


More than 20 million Americans have asthma. For those with mild persistent asthma, guidelines from the National Asthma Education and Prevention Program (NAEPP) currently recommend daily long-term control medication to prevent symptoms and quick- relief medication (inhaled bronchodilator) to treat acute asthma symptoms if they occur.

The recommendation for daily long-term control medication for mild persistent asthma was based largely on clinical trials that showed that anti-inflammatory therapy improves lung function and measures of asthma control. However, participants in these earlier studies had asthma that ranged in severity from mild to moderate, according to the IMPACT authors. The IMPACT study strictly adhered to the guidelines’ definition.

James Kiley, PhD, director of the NHLBI Division of Lung Diseases, commented, "By focusing exclusively on mild persistent asthma, the IMPACT study has added to our understanding of possible treatment options for different levels of asthma severity."

NAEPP is expected to release updated guidelines in 2006. An expert panel will consider the results of IMPACT and other studies to determine if changes in treatment recommendations for adults with mild persistent asthma are warranted.

IMPACT was designed to identify the best long-term treatment strategy for adults with mild persistent asthma. Researchers compared changes in lung function, frequency and severity of asthma symptoms, and quality-of-life scores in 255 adult patients. Participants were randomly selected to one of three treatment groups. Two groups were assigned to long-term control medication taken twice daily -- either an inhaled steroid (budesonide) or a leukotriene modifier (zafirlukast) taken in pill form. The third group received placebo (inactive) medication. All participants were given medications for asthma symptoms -- inhaled bronchodilator (albuterol), inhaled corticosteroid (budesonide), and oral corticosteroid (prednisone) -- with explicit instructions on when and how to use these treatments depending on the severity and duration of the individual’s symptoms.

After one year, changes in lung function and the number of severe attacks did not significantly differ among the three groups. In addition, participants scored similarly on quality-of-life tests regardless of treatment group. Those in the daily inhaled steroid group, however, reported significantly more symptom-free days (equivalent to about 26 additional symptom-free days per year) than participants in the other two treatment groups.

"Although some reports of symptoms differed between those taking budesonide daily and the other participants, these differences were not reflected in the quality-of-life scores," noted Homer Boushey, M.D., Principal Investigator at the University of California San Francisco, and a lead author of the study. "Combined with the fact that there were no significant differences in lung function changes or in the frequency of severe attacks among the treatment groups after a year of treatment, we conclude that, overall, the three treatments had similar clinical effects in this study of mild asthma."

Other reports have noted that many asthma patients do not follow recommendations for daily controller medication. "The results of IMPACT suggest that for some adults with long- standing mild persistent asthma, choosing not to take daily medications might be okay," added Elliot Israel, M.D., Principal Investigator at Brigham and Women’s Hospital in Boston and the co-lead author. "But this choice should be made in consultation with the patient?s healthcare provider. It’s critical that individuals with more severe asthma follow recommendations for daily long-term control medications and that all asthma patients -- even those with mild asthma -- be aware of signs of worsening asthma and adequately treat their symptoms."

Asthma treatment guidelines also recommend written action plans as part of an overall effort to educate patients in self-management. The plans provide guidance for patients on how to monitor and treat their asthma, including how to recognize when their condition worsens. In general, action plans are based on the patient’s symptoms or on "peak flow" measurements of lung function, which can be taken by patients using a hand-held device.

"One of the most important things we did during this study was to work closely with the participants to help them effectively manage their asthma," noted Boushey. "Patients need to know how to recognize asthma symptoms, what to do when symptoms begin, and -- perhaps most essential -- they must have at hand the means to treat their symptoms quickly."

Clinical centers for the Improving Asthma Control Trial were

  • Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
  • Columbia Presbyterian Medical Center and Harlem Lung Center, New York, NY
  • National Jewish Medical and Research Center, Denver, CO
  • University of Wisconsin, Madison
  • Thomas Jefferson Medical College, Philadelphia, PA
  • University of California, San Francisco

The data coordinating center is at Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA.

The medications for IMPACT were donated by Astra-Zeneca Pharmaceuticals, headquartered in Wayne, Pennsylvania.

NHLBI Communications Office | EurekAlert!
Further information:
http://www.nhlbi.nih.gov

More articles from Studies and Analyses:

nachricht New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)

nachricht Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Fighting drug resistant tuberculosis – InfectoGnostics meets MYCO-NET² partners in Peru

28.04.2017 | Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

 
Latest News

Wireless power can drive tiny electronic devices in the GI tract

28.04.2017 | Medical Engineering

Ice cave in Transylvania yields window into region's past

28.04.2017 | Earth Sciences

Nose2Brain – Better Therapy for Multiple Sclerosis

28.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>