Asthma Sufferers Have More Options to Control Disease
research by the American Lung Association’s
Asthma Clinical Research Centers has revealed
that people with mild asthma that is well-controlled
with twice-daily use of inhaled steroids may be able
to reduce inhaler use to once a day – or
switch to a daily pill.
is good news for patients with mild, persistent asthma because
it gives them more choices about how to manage their disease,” says
Stephen P. Peters, M.D., Ph.D., lead author and a professor of
pediatrics, internal medicine-pulmonary and associate director
of the Center for Human Genomics.
The study involved
500 children and adults with mild asthma. The goal of the study
team was to determine if
patients whose symptoms are well controlled on twice daily inhaled
corticosteroid can “step down” their medication use.
of the study can be found in the May 17, 2007, issue
of the New England Journal of Medicine. Asthma is considered
mild, but persistent, when symptoms occur more than two times
a week or cause the patient to wake up during the night more
than twice a month. The standard treatment for mild-persistent
asthma is twice-daily use of an inhaled steroid to prevent symptoms.
Patients may also take additional drugs such as the inhaler albuterol,
known as “rescue” therapy,
to treat symptoms.
of people with asthma have mild disease, according to Peters.
The study involved patients whose asthma was treated with twice-daily
inhaled fluticasone propionate (Flovent® Discus), a commonly
prescribed synthetic steroid. This drug is designed to suppress
inflammation within the airways that can cause narrowing. Study
participants were randomly divided into three groups. One group
continued to take Flovent twice a day for 16 weeks. Two other
groups took alternative therapies: either a combination of fluticasone
propionate and salmeterol in a single inhaler (Advair® Discus)
once daily or the oral medication montelukast (Singulair®)
that blocks chemicals produced by the body that cause inflammation,
also taken once daily. Salmeterol, used in the combination therapy,
is a long-acting bronchodilator, or a drug that relaxes and opens
The study measured
rates of treatment failure among the three groups. Treatment
failure included hospitalization or urgent medical care, the
need for additional medications for asthma, a decline in lung
function, or the need to take more than 10 puffs a day of a “rescue” inhaler for
two consecutive days. The groups taking twice-daily fluticasone
and once-daily fluticasone/salmeterol both had a treatment failure
rate of 20 percent. In the group taking montelukast, the rate
was 30 percent.
study suggests that patients whose asthma is well controlled on
twice-daily fluticasone can be switched to once-daily flucitasone/salmeterol
without increased rates of treatment failure,” says Peters.
He said that even though montelukast had a higher rate of treatment
failure than the inhaled medications, it can also be considered
an option for some patients, since a majority of patients also
did well on this treatment.
“While the group on the combination
inhaler therapy clearly did better than those on the oral montelukast
therapy, it is important to note that 70 percent of patients on
this oral therapy did well according to the treatment failure criteria,
and were symptom-free on 79 percent of days,” said Peters. “Patients
should find a therapy that that works for them and fits their desires,
preferences and lifestyle.”
fluticasone/salmeterol once daily were symptom-free 83 percent
of days and those on fluticasone/salmeterol were symptom-free
for 86 percent of days. Peters said two factors determine a medication’s effectiveness: how well it works
when it is taken as prescribed and how well patients adhere to
the therapy. He said patients may adhere better to therapy that
is required once a day – or that involves taking a pill rather
than using an inhaler. In addition, while the risks of low-dose
steroids are low, some patients may perceive a risk and be more
willing to take the drugs if they are only required once a day.
who are doing well with the gold standard which is twice a day
inhaled corticosteroid, but want to try other options, should talk
to their doctors,” says Peters. He cautions, however, that
it should be noted that a limitation of the study is that it was
conducted for only 16 weeks and that flutcasone/salmeterol is currently
approved by the U.S. Food and Drug Administration for twice-daily
of the writing committee were Nicholas Anthonisen, M.D., Mario
Castro, M.D., Janet T. Holbrook, M.P.H., Ph.D., Charles G. Irvin,
Ph.D., Lewis Smith, M.D., and Robert A. Wise, M.D. Wake Forest
University Baptist Medical Center is an academic health system
comprised of North Carolina Baptist Hospital and Wake Forest
University Health Sciences, which operates the university’s
School of Medicine. The system comprises 1,238 acute care, psychiatric,
rehabilitation and long-term care beds and is consistently ranked
as one of “America’s Best Hospitals” by U.S.
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