Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Dual therapy works best for controlling asthma

19.10.2005


A combination of airway-opening drugs and inhaled inflammation-reducing steroids works better at preventing severe asthma attacks than a normal dose of steroids alone, according to a new review of recent studies.

However, higher doses of steroids seem to be just as effective as the combination therapy in preventing these attacks, a second review concludes.

The studies focus on the effects of long acting beta-2 agonist (LABA) drugs. Unlike "rescue" inhalers, which can immediately open airways during an asthma attack, LABA medications keep bronchial airways relaxed and open over a 12-hour period. The drugs include salmeterol, which is sold under the brand name Serevent and is also an ingredient in the Advair inhaler, and formoterol, sold under the brand name Foradil.



Asthma patients who used both LABA medication and an inhaled steroid were significantly less likely to have a severe asthma flare-up requiring treatment with an injected or swallowed steroid than patients taking the steroid alone, according to Muireann Ni Chroinin, M.D., of the Norfolk and Norwich University Hospital in England, and colleagues.

The reviews appear in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The rate of severe attacks dropped from 27 percent to 22 percent in patients taking the combination therapy. Ni Chroinin and colleagues calculate that 18 patients would need to be treated with LABA for one year to prevent at least one patient from having such an attack.

Combination therapy also improved overall lung function, increased the number of days where patients said they felt free of asthma symptoms and decreased the patients’ use of rescue inhalers, compared to inhaled steroids alone, the researchers found.

For patients who continue to have asthma symptoms while using an inhaled steroid medication, "the addition of long-acting beta-2 agonist is superior to remaining on similar doses of inhaled steroids alone," Ni Chroinin says.

In a second review, Ilana Greenstone, M.D., of McGill University Health Center in Canada and colleagues concluded that a double dose of inhaled steroids worked just as well as combination therapy in reducing the rate of severe asthma attacks.

But the combination therapy "clearly leads to greater improvement in lung function and symptoms than a two- to two-and-a-half-fold higher dose of inhaled corticosteroids," according to Greenstone. There was a 12 percent increase in symptom-free days among patients taking LABA and steroids, compared to those taking the higher steroid dose. Patients on the combination therapy also reduced their rescue inhaler use by as much as one less "puff" per day.

There were no significant differences in side effects between the combination therapy and higher steroid doses except for a three-fold increase in the rate of tremor, or uncontrolled muscle contractions, in the patients taking LABA medications, the researchers found.

Ni Croinin and colleagues reviewed 26 studies that included 8,147 patients. Greenstone and colleagues analyzed 30 studies that included 9,509 patients. Only eight of the studies in the Ni Croinin review and three studies in the Greenstone review focused on children with asthma.

"I think the lack of data for pediatrics is certainly a problem which may limit the use of LABA in that age group. There just aren’t enough studies to make evidence-based clinical decisions," Greenstone says.

The Cochrane reviewers say their work may help physicians decide when or if to prescribe LABA medications to asthma patients already taking inhaled steroids.

"My sense is that there is a tendency to initiate combination therapy with inhaled corticosteroids and LABAs," rather than start with steroids and add LABA drugs later on in patients with uncontrolled asthma, says Jerry Krishnan, M.D., an asthma researcher and assistant professor of medicine and epidemiology at the Johns Hopkins University School of Medicine. "This practice is likely to be driven in part by the step-down approach, where more aggressive therapy is initiated, then stepped down once control is achieved."

Almost all the studies reviewed by both Ni Croinin and Greenstone and colleagues were sponsored by the manufacturers of either LABA medications or inhaled steroids. Francine Ducharme, M.D., an author on both reviews, has received speaking and consulting fees from AstraZeneca (producer of formoterol and the steroid budesonide), GlaxoSmithKline (producer of the steroids fluticasone and beclomethasone and salmeterol), and Novartis (producer of formoterol).

Muireann N Ni Chroinin | EurekAlert!
Further information:
http://www.nnuh.nhs.uk
http://www.hbns.org

More articles from Health and Medicine:

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

nachricht The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

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

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

Im Focus: Fraunhofer ISE Develops Highly Compact, High Frequency DC/DC Converter for Aviation

The efficiency of power electronic systems is not solely dependent on electrical efficiency but also on weight, for example, in mobile systems. When the weight of relevant components and devices in airplanes, for instance, is reduced, fuel savings can be achieved and correspondingly greenhouse gas emissions decreased. New materials and components based on gallium nitride (GaN) can help to reduce weight and increase the efficiency. With these new materials, power electronic switches can be operated at higher switching frequency, resulting in higher power density and lower material costs.

Researchers at the Fraunhofer Institute for Solar Energy Systems ISE together with partners have investigated how these materials can be used to make power...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

UTSA study describes new minimally invasive device to treat cancer and other illnesses

02.12.2016 | Medical Engineering

Plasma-zapping process could yield trans fat-free soybean oil product

02.12.2016 | Agricultural and Forestry Science

What do Netflix, Google and planetary systems have in common?

02.12.2016 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>