New research points that a combination of inhaled steroids and long acting beta agonist (LABA) does not reduce the incidence of severe Chronic Obstructive Pulmonary Disease (COPD) exacerbations.

Further studies show that combined treatment increased the patient’s risk of developing pneumonia by 63 percent, viral respiratory infections by 22 percent and fungal infections in the mouth, such as oral thrush, by 59 percent.

However, the combination therapy significantly reduced the risk of moderate COPD flare-ups compared with single drug therapy.

Overall mortality rate was not reduced using the two-drug approach compared to the single drug therapy.

Dr. Gustavo J. Rodrigo from the Hospital Central de las Fuerzas Armadas in Montevideo, Uruguay, and his associates, reviewed the efficacy of the combination therapy versus the single drug therapy.

After this extensive systematic review, Dr. Rodrigo and associates pointed out the flaw in the current guidelines in treating patients with COPD. The drug combination is still being used for severe and very and severe COPD patients.

According to the authors, the benefits did not reach the suggested clinically important minimal differences.

They concluded that patients with severe COPD should be better treated with LABA alone, until further research would identify which type or severity of COPD would most likely benefit from the combined therapy.

From Reuters Health:

NEW YORK (Reuters Health) - In people who suffer from COPD, a progressive lung disease that makes it hard to breathe, adding an inhaled steroid to a so-called “long-acting beta-2 agonist” may do more harm than good, new research hints.

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A new drug, RPL554, which faced trial at the Centre for Human Drug Research (CHDR) in the Netherlands on as many as 60 people in 2008, is expected to be completed by the summer of 2009.

This drug is aimed at treating asthma, which affects more than 1.5 million people in the United States alone, and hay fever. It is believed that the drug could be made available in approximately three to four years if the initial trials for safety and efficacy are found to be successful.

From News-Medical.Net:

Current treatments for asthma and hay fever sufferers are beta-agonists, which open up the airways, and inhaled steroids, which dampen down the inflammation that causes irritation - they are either taken together or singly.

But they have serious side effects, including possible harm to the cardiovascular system and the ’shakes’ reported by many patients from excess use.

Experts say little progress has been made recently with alternative, effective and practical treatment options for a wide range of people with asthma and hay fever and by combining anti-inflammatory properties and the ability to overcome airway narrowing in a single long-lasting dose via the nose, RPL554 could offer real hope of a significant breakthrough.

It is considered by many researchers that this once-a-day treatment option will be regarded as a potential breakthrough when it comes to treating asthma and hay fever. The treatment option would bring relief to asthma sufferers and its use would mean that asthmatic people would be requiring only a single needle puff from their “lifesaving” inhalers to stop the symptoms.

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According to a new review of recent studies, a combination of airway-opening drugs and inhaled steroids with inflammation-reducing properties works better when it comes to the prevention of severe asthma attacks than a normal dose of steroids alone.

It was proved, however, that higher doses of steroids prove to be as effective as the combination therapy for preventing asthma attacks as per a second review.

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.

Jerry Krishnan, M.D., an asthma researcher and assistant professor of medicine and epidemiology at the Johns Hopkins University School of Medicine, said that he believes that there is a tendency for the initiation of combination therapy with LABAs (long acting beta-2 agonists) and inhaled corticosteroids.

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According to a study that was presented at the American Thoracic Society, there may be occasions when some children may find it difficult to control asthma when they are administered with inhaled corticosteroids, one of the most popular forms of asthma treatment.

The study was quick to highlight that some children may be genetically less responsive to steroids, a fact that was brought into notice by Gregory Sawicki, M.D. of Children’s Hospital in Boston.

From News-Medical.Net:

“The majority of children with mild asthma are less likely to have symptoms as they get older and may not need to be on daily steroids,” Dr. Sawicki said. “The flip side is that if a child has poor asthma control, the parents and doctor need to make sure the child is adhering to their inhaled steroid treatment. But variation in response to inhaled steroids, as other medications, is well described.”

The data comes from the Child Asthma Management Program Continuation Study (CAMPCS), one of the largest groups of children with mild to moderate asthma in the nation who have been followed over 10 years. “This study gives us a good sense of real-world practice in asthma management,” Dr. Sawicki says. “The children’s care is not directed by anyone in the study; it’s an observation of what goes on when the children’s care is directed by their own physicians.”

Dr. Sawicki went on to remark that it had already been communicated in the past that even an extensive use of inhaled steroids may not prove its worth for well-controlled asthma in every adult asthmatic patient. This study is believed to provide a new direction to doctors who have been findings ways to control asthma in their patients with little or no success.

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A cataract is a clouding that develops in the eye, particularly in the crystalline lens or in its envelope. It varies in degree from being slight opaque to being completely opaque. Cataracts can completely obstruct the passage of light.

Symptoms include blurring of vision, glare sensitivity, poor night vision, double visions, and a yellowing of colors similar to looking through a frosted window. Cataract is not caused by eye overuse, nor does it spread from one eye to another. It is not a film coating the eye surface.

The most common type of cataract is age-related. This type is called senile cataract. However, studies have shown a link between the use of steroids and the formation of cataracts.

In one study conducted in England and Wales, they found that 11.5% of the participants were on inhaled steroids for the treatment of their asthma condition. Only 7.5% were found to have no symptoms of cataract.

The study also showed an increase in incidence among patients who were taking higher doses of inhaled steroids. Those who were taking the lowest daily dose of 400 mcg were found to have little or no risk at all. Those who were on 1,600 mcg per day dose have 70% greater incidence of cataract formation. The risk also increases with prolonged use of inhaled steroids.

From Web MD:

Older adults who use inhaled steroids to manage their asthma may be slightly more likely to develop cataracts than others, a new study suggests.

Researchers say previous research has shown that steroids that are taken as pills or delivered intravenously (by vein) increase the risk of cataracts, or clouding of the clear lens that covers the eye. But this is the first study to examine whether inhaled steroids also carry a risk of cataracts.

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New findings have been revealed with regard to use of chronic corticosteroid at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle.

According to Rebecca Green, M.D., Ph.D., Assistant Professor, Pediatric Endocrinology and Diabetes, Washington University School of Medicine in St. Louis, Mo., corticosteroids have been considered to be miracle drugs for many ailments when it comes to controlling symptoms where other medications failed to deliver any good results.

From News-Medical.Net:

The side effects attributed to corticosteroids include decreased bone mineral density and reduced bone mass, and also in children, reduced growth rate. According to Dr. Green, strategies to alleviate these effects include minimizing oral doses and adding topical or inhaled steroids to provide the same anti-inflammatory benefit in the areas affected by inflammation while avoiding systemic effects. Disturbance in bone acquisition in childhood can reduce peak bone mass and therefore significantly impact the life time risk of osteoporosis.

“One of the challenges has been distinguishing the effects of the inflammatory process itself on bone mass and growth, and the effects of corticosteroids on bone growth from the effects of corticosteroids on bone mass,” she said.

“Analysis of large population databases has recently yielded extremely valuable data about corticosteroids and fractures, with some unexpected impact of lower doses. Analysis of the same database for inhaled steroid use in adults showed a small increase in fracture risk in users of inhaled steroids compared to control, but comparable risk of fracture in inhaled steroid users compared to individuals using inhaled bronchodilators. This suggests that the increased risk of fracture was secondary to the disease itself, not the inhaled steroids,” Dr. Green explained.

As per Dr. Kelly, Professor Emeritus Of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, N.M., the use of inhaled corticosteroids has the potential for minimizing bone mineral growth in male children who are progressing through the stage of puberty, but the associated risk is more likely to be outweigh by an ability to minimize the quantity of oral corticosteroids used in these children.

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Prescribing inhaled steroids to COPD patients now comes with a warning from General Physicians (GPs) due to the associated risk of pneumonia.

The Medicines and Healthcare Regulatory Agency, which is regarded as the government’s drug safety watchdog, suggested that steroids are presently introduced much earlier than the present medical guidelines recommend. It was revealed that combining LABA (Long acting β2-agonists) with inhaled steroids does not bring any significant advantages in mild ailments but the risk of pneumonia is increased considerably due to intake of steroids.

From Pulsetoday.co.uk:

The government’s drug safety watchdog, the Medicines and Healthcare Regulatory Agency, suggests steroids ‘are being introduced earlier than current guidelines recommend’.

It says combining LABAs with inhaled steroids has no proven significant benefits in mild disease, but that steroids significantly increase the risk of pneumonia.

NICE guidance, currently under review, says inhaled steroids should be added for severe disease with an FEV1 under 50% and where there are repeated exacerbations.

Combination is better than monotherapy in all trials that have compared the two treat-ments, but the benefit is limited.

Inhaled steroids should be limited to when COPD progresses to severe disease, and never on their own, the MHRA says.

These findings were supported by Dr Steve Holmes, a GP in Shepton Mallet, Somerset and education lead of the General Practice Airways Group, who termed them as ‘very sensible.’

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As per a new study presented at the American Thoracic Society, some asthmatic children are not able to keep up their asthma under a controlled state despite consistently using inhaled corticosteroids as per qualified medical advice.

It was remarked that some children may be genetically less responsive than others when it comes to steroid treatment for their asthma, as per researcher Gregory Sawicki, M.D. of Children’s Hospital in Boston. Dr. Sawicki also remarked that even several studies with relation to adult asthmatic individuals suggested that rigorous use of inhaled steroids does not always lead to controlled asthma.

From News-Medical.Net:

Of the 914 children in the study, inhaled steroids were recommended for 435 who had persistent asthma, meaning they had symptoms on a regular basis. Among children who weren’t recommended for inhaled steroid treatment, most reported well-controlled asthma. Among those recommended for inhaled steroid treatment, 44% reported consistently using the medicine; 35% said they intermittently used the medicine and 21% said they didn’t use it at all.

“The majority of children with mild asthma are less likely to have symptoms as they get older and may not need to be on daily steroids,” Dr. Sawicki said. “The flip side is that if a child has poor asthma control, the parents and doctor need to make sure the child is adhering to their inhaled steroid treatment. But variation in response to inhaled steroids, as other medications, is well described.”

The data comes from the Child Asthma Management Program Continuation Study (CAMPCS), one of the largest groups of children with mild to moderate asthma in the nation who have been followed over 10 years. “This study gives us a good sense of real-world practice in asthma management,” Dr. Sawicki says. “The children’s care is not directed by anyone in the study; it’s an observation of what goes on when the children’s care is directed by their own physicians.”

Dr. Sawicki also said that a big majority of children with mild asthma are likely to develop fewer symptoms as they get older and the need to be on a daily steroid dosage may get reduced with the passing time.

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According to a study, pregnant women with asthma who are carrying a female baby are more likely to experience a worsening of their asthma than pregnant asthmatic women carrying a baby boy. According to Dr. Peter G. Gibson, the reason for this difference is unknown although he says that female fetus may produce a substance in response to the inflammation of the asthmatic mother’s airways that somehow worsens the asthma.

From Medical News Today:

The study followed 151 pregnant women; 33 did not have asthma, 38 had asthma but did not use inhaled steroids during pregnancy, and 80 had asthma and used inhaled steroids every day during their pregnancy. Steroids control the inflammation of the airways that occurs in asthma. “Inhaled steroids are generally considered safer for the fetus than oral steroids,” Dr. Gibson said.

He found that 60% of asthmatic women who were pregnant with a male fetus were symptom-free throughout their pregnancy and did not report nighttime breathing problems from the 18th to the 30th week of pregnancy. In contrast, 61% of asthmatic women pregnant with a female fetus were symptom-free at 18 weeks, but at 30 weeks only 28% were symptom-free. Nighttime symptoms increased significantly from 18 to 30 weeks in women pregnant with a female fetus.

Use of inhaled steroids increased significantly in asthmatic women pregnant with a female fetus, but did not change in asthmatic women pregnant with a male.

In a previous study published by Dr. Gibson, mothers with untreated asthma had smaller female babies than mothers whose asthma was treated with steroids during pregnancy. Using of inhaled steroids increased significantly in asthmatic women pregnant with a female fetus than those with male fetuses. Treating pregnant asthmatic women is important because attacks can result in reduced oxygen to the baby, which is needed for normal growth and development.

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Most cases, asthma patients are told to take more steroid inhaler doses to get the disease back under control. This practice is believed to be faulty by some Nottingham, UK researchers. The key to asthma therapy is getting the symptoms under control, so that patients suffer fewer attacks and need less of their reliever inhalers.

The team from City Hospital Nottingham (UK) launched a study to test whether the extra steroids were having an impact. They found that doubling the dose of inhaled steroids had no impact on the length of time it took for peak flow to return to normal levels.

From Medical News Today:

Advice to asthmatics to boost their intake of drugs when their condition deteriorates may be flawed, say Nottingham (UK) researchers.

They gave patients an extra supply of inhalers, and told them to break into it when their peak flows began to worsen.

Some patients, however, received dummy inhalers with no drug in them.

The two groups were then compared to see if the extra steroids were good for the patient.

‘Our findings provide little support for the recommendation that patients taking an inhaled corticosteroid should double the dose when asthma control is deteriorating.’ they wrote.

‘Such advice should include, as the authors of this paper say, a reserve supply of steroid tablets.’

The UK research team also found out that increasing the dose of inhaled steroids had no effect on the number of patients who ended up needing more powerful steroids in pill form to control their asthma. The study does not in any way detract from the British Asthma Guideline recommendation that people with asthma should be given personalized advice as to how to alter their therapy themselves to keep themselves well. But the findings should give healthcare providers more information about how to manage deteriorating asthma.

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