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 'Icebreaker' protein opens genome for t cell development, Penn researchers find
21.02.2018 | University of Pennsylvania School of Medicine

nachricht Similarities found in cancer initiation in kidney, liver, stomach, pancreas
21.02.2018 | Washington University School of Medicine

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: In best circles: First integrated circuit from self-assembled polymer

For the first time, a team of researchers at the Max-Planck Institute (MPI) for Polymer Research in Mainz, Germany, has succeeded in making an integrated circuit (IC) from just a monolayer of a semiconducting polymer via a bottom-up, self-assembly approach.

In the self-assembly process, the semiconducting polymer arranges itself into an ordered monolayer in a transistor. The transistors are binary switches used...

Im Focus: Demonstration of a single molecule piezoelectric effect

Breakthrough provides a new concept of the design of molecular motors, sensors and electricity generators at nanoscale

Researchers from the Institute of Organic Chemistry and Biochemistry of the CAS (IOCB Prague), Institute of Physics of the CAS (IP CAS) and Palacký University...

Im Focus: Hybrid optics bring color imaging using ultrathin metalenses into focus

For photographers and scientists, lenses are lifesavers. They reflect and refract light, making possible the imaging systems that drive discovery through the microscope and preserve history through cameras.

But today's glass-based lenses are bulky and resist miniaturization. Next-generation technologies, such as ultrathin cameras or tiny microscopes, require...

Im Focus: Stem cell divisions in the adult brain seen for the first time

Scientists from the University of Zurich have succeeded for the first time in tracking individual stem cells and their neuronal progeny over months within the intact adult brain. This study sheds light on how new neurons are produced throughout life.

The generation of new nerve cells was once thought to taper off at the end of embryonic development. However, recent research has shown that the adult brain...

Im Focus: Interference as a new method for cooling quantum devices

Theoretical physicists propose to use negative interference to control heat flow in quantum devices. Study published in Physical Review Letters

Quantum computer parts are sensitive and need to be cooled to very low temperatures. Their tiny size makes them particularly susceptible to a temperature...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

2nd International Conference on High Temperature Shape Memory Alloys (HTSMAs)

15.02.2018 | Event News

Aachen DC Grid Summit 2018

13.02.2018 | Event News

How Global Climate Policy Can Learn from the Energy Transition

12.02.2018 | Event News

 
Latest News

Researchers invent tiny, light-powered wires to modulate brain's electrical signals

21.02.2018 | Life Sciences

The “Holy Grail” of peptide chemistry: Making peptide active agents available orally

21.02.2018 | Life Sciences

Atomic structure of ultrasound material not what anyone expected

21.02.2018 | Materials Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>