According to a review of studies, severe asthma attacks can be better prevented with a combination of airway opening drug and inhaled steroids having inflammation-minimizing characteristics rather than a normal steroid dose.

The study suggested that higher doses of steroids can prove to be an effective part as part of a combination therapy for preventing the occurrence of asthma attacks.

From News-Medical.Net:

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.

There is a tendency of starting combination therapy with LABAs (long acting beta-2 agonists) and inhaled corticosteroids among practitioners at an early stage, as per Jerry Krishnan, M.D., an asthma researcher and assistant professor of medicine and epidemiology at the Johns Hopkins University School of Medicine.

Tags: inhaled corticosteroids, Inhaled steroids, long acting beta-2 agonist, steroids

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According to results from the Childhood Asthma Research and Education (CARE) Network supported by the National Heart, Lung, and Blood Institute (NHLBI), breathing problems in pre-school-aged children at high risk for asthma can be reduced to a considerable extent when inhaled corticosteroids are used on a daily basis.

It was also noted that corticosteroids are not effective for preventing the development of persistent asthma in these children.

From News-Medical.Net:

Studies in older children and adults show that the most effective long-term control medicine for persistent asthma (symptoms more than two days a week or more than twice a month at night) is inhaled corticosteroids, which reduce airway swelling and help prevent asthma symptoms (e.g., asthma attacks). The Prevention of Early Asthma in Kids (PEAK) multicenter clinical trial, published in the May 11, 2006, issue of the New England Journal of Medicine, answers a question that pediatricians and researchers have been asking for years: Can medicine that treats the inflammation of asthma be used to prevent the disease if given early enough in at-risk patients?

“Asthma is an enormous public health problem, and this study was designed to see if we could stop the development of asthma in its tracks – while the lungs are still developing – in young children known to be at high risk,” said NHLBI Director Elizabeth G. Nabel, MD. “Although this study shows that inhaled corticosteroids do not prevent chronic asthma, it provides clear evidence that inhaled corticosteroids benefit even some of our youngest patients.”

The PEAK study results support extending the use of inhaled corticosteroids to pre-school children at high risk for asthma.

Tags: Asthma, chronic asthma, inhaled corticosteroids

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Asthma patients in general experience improved clinical outcomes with oral controllers than inhaled corticosteroids. This finding appeared in Mayo Clinic Proceedings that were published in a peer-reviewed comparative effectiveness study performed by HealthCore, Inc. in its August edition.

Dr. Joseph Singer, vice president of clinical affairs for HealthCore, the outcomes research subsidiary for WellPoint, said that the study was requested to ensure that WellPoint’s National Pharmacy and Therapeutics Committee’s drug formulary for asthma therapies was aligned with their real-world use and outcomes.

From News-Medical.Net:

The study, “Impact of Asthma Controller Medications on Clinical, Economic and Patient-Reported Outcomes,” revealed that users of oral controllers were significantly better at adhering to their medication than users of inhaled corticosteroids and probably obtained greater treatment benefit. After the study was complete in 2008, WellPoint’s National Pharmacy and Therapeutics Committee chose to keep the oral controller used by the vast majority of its members on the same preferred formulary tier and lift its prior authorization requirement.

Asthma is a common and chronic inflammatory disorder of the airways that affects more than 22 million Americans. In 2004, it resulted in 14.7 million outpatient visits, 1.8 million emergency department visits and nearly 500,000 hospitalizations.

“It’s important for physicians and health plans alike to know that ‘one size fits all’ does not apply when treating asthma patients,” said Singer. “These results speak to the power of comparative effectiveness research and its ability to give physicians the information they need to customize treatment for patients in the real world.”

Lead authors of the HealthCore study were HealthCore researchers Hiangkiat Tan, Chaitanya Sarawate and Dr. Joseph Singer. Other authors included Dr. Kurt Elward, Dr. Rubin Cohen, Dr. Brian Smart, Dr. Michael Busk, Dr. James Lustig, Dr. Jeana O’Brien, and Dr. Michael Schatz.

Tags: Asthma, corticosteroids, inhaled corticosteroids

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A review of studies that were aimed at making comparisons between two asthma treatment options: inhaled corticosteroids and cromolyn has found that asthmatic patients, both adults and children, can exercise a better control and breathe deeper while being on corticosteroids.

James Guevara, M.D., of the University of Pennsylvania School of Medicine and colleagues found out that patients administered with corticosteroids make lesser use of life-saving “inhalers” than their counterparts on cromolyn and even scored better on lung function tests.

From News-Medical.Net:

“To our knowledge, this is the first systematic review comparing the effects of cromolyn to the gold standard, inhaled steroids,” Guevara said.

The review appears 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 consensus still leaves room for cromolyn treatment, according to William Storms, M.D., an allergist at the University of Colorado Health Sciences Center and director of the William Storms Allergy Clinic in Colorado Springs.

“Any expert would agree that inhaled corticosteroids are preferred first-line therapy for treatment of persistent asthma, which requires daily therapy. But we also will agree with the NIH [National Institutes of Health] asthma guidelines, which state that cromolyn and other drugs are alternative therapies,” Storms said.

Cromolyn, or sodium cromoglycate, and inhaled corticosteroids both block the action of certain inflammatory cells in the lungs. Physicians recommend both types of medication for persistent asthma, but individual studies disagree about which type of medication works best, the reviewers found.

Guevara and colleagues noted that the benefits and superiority of inhaled corticosteroids are more than that of cromolyn, irrespective of the severity level of asthma. It was also noted that the results were so decisive that there is absolutely no further need to warrant any more studies to make similar comparisons.

Tags: Asthma, corticosteroids, cromolyn, inhaled corticosteroids, inhalers, sodium cromoglycate, steroids, treating asthma

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According to a recent study, inhaled corticosteroids are better than sodium cromoglycate when it comes to improving lung function and managing asthma in an effective manner.

Dr James Guevara, Department of Pediatrics at the University Of Pennsylvania School Of Medicine in Philadelphia and lead review author of this study, said that the superiority of corticosteroids tend to improve with moderately low doses when compared with low doses.

From News.Bio-Medicine.org:

Inhaled corticosteroids (ICS) and sodium cromoglycate (SCG) are both used to help people with asthma. SCG is believed to have a low risk of causing long-term side effects, but despite anxieties relating to routine use of steroids, the use of ICS has steadily increased since the 1990s.

While they are both known to work, there has previously been a debate as to whether one is superior to the other.

By pooling data from randomized controlled trials that directly compared the effects of ICS and SCG the Cochrane Review Authors could assess the relative benefits of each. They considered measures of lung function, asthma control and the use of general healthcare services such as GPs and hospitals.

Their conclusion was that ICS controls asthma better than SCG and that it also leads to improved lung function. They were, however, unable to decide whether there were differences in side-effects as most of the trials ran for too short a time to assess long-term outcomes.

“The superiority of ICS over SCG appears to increase when patients use moderate doses of ICS, compared with when low doses of ICS are used,” says lead Review Author Dr James Guevara, who works in the department of Pediatrics at the University of Pennsylvania School of Medicine in Philadelphia.

The study finding is expected to bring back a smile on the faces of around one million people suffering from asthma in the United States alone.

Tags: Asthma, inhaled corticosteroids, sodium cromoglycate

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According to a review of studies comparing inhaled corticosteroids and cromolyn, it was noted that adults and children suffering from asthma and using inhaled corticosteroids fared better than those using cromolyn.

James Guevara, M.D., of the University of Pennsylvania School of Medicine and colleagues, said that patients on steroids had on average three fewer severe asthma flare-ups each year, scored better on lung function tests, and make lesser use of inhalers than their counterparts on cromolyn.

From News-Medical.Net:

“Any expert would agree that inhaled corticosteroids are preferred first-line therapy for treatment of persistent asthma, which requires daily therapy. But we also will agree with the NIH [National Institutes of Health] asthma guidelines, which state that cromolyn and other drugs are alternative therapies,” Storms said.

Cromolyn, or sodium cromoglycate, and inhaled corticosteroids both block the action of certain inflammatory cells in the lungs. Physicians recommend both types of medication for persistent asthma, but individual studies disagree about which type of medication works best, the reviewers found.

“The safety of sodium cromoglycate has been well established, but the effectiveness of sodium cromoglycate in controlling asthma symptoms may be limited,” Guevara said, adding that the lack of effective control might be one reason cromolyn has fallen out of favor compared to inhaled corticosteroids since the 1990s.

William Storms, M.D., an allergist at the University of Colorado Health Sciences Center and director of the William Storms Allergy Clinic in Colorado Springs, said that the consensus still provides room for cromolyn treatment.

Tags: corticosteroids, cromolyn, inhaled corticosteroids, steroids

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According to a new study that was published in an issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), chronic obstructive pulmonary disease (COPD) patients using inhaled corticosteroids are likely to have a considerably reduced mortality risk.

It was revealed by the researchers that patients receiving inhaled corticosteroids within a period of 30 days of hospital discharge had a 25 percent reduced all-cause mortality rate. It was also noted that patients using steroids paired with beta-agonists saw a fall in cardiovascular-related deaths by 38 percent.

From News-Medical.Net:

Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.

“Our results indicate that the effect of inhaled corticosteroids is relatively short-term and that those currently using it are relatively better protected, ” said Dr. Macie. “Inhaled corticosteroids should be prescribed as soon as clinically indicated. By treating COPD with inhaled corticosteroids, we have the potential to reduce the effect and prolong life.”

“The findings from this study are intriguing for clinicians and point to the need for further research to define the role and mechanisms of the effect of inhaled corticosteroids on both cardiovascular and respiratory mortality,” said W. Michael Alberts, MD, FCCP, President of the ACCP.

Author Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada, said that COPD is an underrated lung ailment that has associated lung disease.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, inhaled corticosteroids

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In the largest study of its kind on preschoolers, it was noted that high doses of inhaled corticosteroids are effective for minimizing the severity and duration of asthma attacks triggered by colds

The study was published in the New England Journal of Medicine and led by Dr. Francine Ducharme, assistant director of clinical research at the Sainte-Justine Hospital Research Center and a pediatrics professor at the Université de Montréal.

From News-Medical.Net:

The research team found that high doses of corticosteroids (fluticasone), when inhaled at the onset of a cold and taken for up to 10 days, reduces the number of moderate or severe asthma attacks that require emergency oral steroids. This is the first study whose findings clearly demonstrate the treatment’s efficacy in young children requiring oral corticosteroids or hospital admission because of the severity of this type of asthma attack.

The breakthrough is all the more important, since this age group represents more than half (60 percent) of children that go to emergency departments or are admitted to hospital for asthma attacks. Although viral-induced asthma is frequent in preschool-aged children, optimal management of this disease remains elusive. That’s why Dr. Ducharme has focused her research on improving treatment for asthmatic children, particularly those of preschool age

The involved researchers still need to confirm if children can make up for slight growth retardation as the average growth rate of the untreated children was about 6.5 cm as opposed to 6.0 cm in the children treated with fluticasone, the corticosteroid.

Tags: corticosteroid, fluticasone, inhaled corticosteroids

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After an evidence was found suggesting that some of the presently-used anti-inflammatory medications increase the risk of pneumonia by a full third, Lung disease experts at Johns Hopkins made a call for caution while recommendations are made by doctors while prescribing inhaled corticosteroids to people with COPD (chronic obstructive pulmonary disease).

COPD is believed to affect more than 11 million Americans on a yearly basis and most of this affected population belongs to the category of present or former smokers.

From News-Medical.Net:

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

Pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, remarked that findings of this study are expected to provide a reminder to patients with severe lung disease to plan and take steps for reducing the risk of pneumonia, which doubles their risk of dying.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, inhaled corticosteroids, pneumonia

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A call for greater caution for prescribing inhaled corticosteroids to people with COPD (chronic obstructive pulmonary disease) was made by Lung disease experts at Johns Hopkins. The call was made after evidence suggested that some of the most widely-used anti-inflammatory medications may increase the risk of pneumonia by a full third.

It is considered that more than eleven million Americans are suffering from COPD and many of them belong to the former or current smokers’ category.

From News-Medical.Net:

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

Lead author of this study, pulmonologist M. Brad Drummond, M.D., M.H.S., said that the latest finding is a reminder to the medical fraternity and patients with severe lung disease to plan and take steps to reduce the risk of catching pneumonia, which doubles their risk of dying.

Tags: chronic obstructive pulmonary disease, COPD, corticosteroids, inhaled corticosteroids, pneumonia

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