New Treatments Improve Control for Severe Asthma

MONDAY March 16, 2009 -- Over just one decade, new asthma medications and tools have significantly improved the management of this serious airway disease.

When compared to children treated in the mid-'90s, children with severe asthma during 2004 to 2007 were less likely to need oral steroids and rescue inhalers, and their lung function scores were improved, according to a study from National Jewish Health in Denver.

"The current cohort was less likely to require chronic oral glucocorticoids, have better asthma control and have fewer glucocorticoid-induced adverse effects compared to a cohort of severe asthmatic children studied a decade ago," wrote the authors.

Results of the study were expected to be presented Saturday at the American Academy of Allergy, Asthma & Immunology (AAAAI) annual meeting, in Washington, D.C.

To assess whether or not newer medications such as newer inhaled steroids, combinations of inhaled steroids and long-acting bronchodilators (Advair), and leukotriene receptor antagonists (Singulair) had made a positive impact on asthma treatment, the researchers compared a group of 65 children referred to the hospital between 2004 and 2007 to 164 children who were referred to National Jewish between 1993 and 1997. All of the children had severe asthma.

Just over three quarters of the present-day group were on a leukotriene receptor antagonist, and two-thirds were on combination medication. None of the group from the '90s took any of these medications.

Compared to the historic group, the present-day children were less likely to need oral steroids -- 28 percent of the current group vs. 51 percent of the historic group. When oral steroids were needed, the present-day group required only about one-quarter of the dose that was required 10 years earlier.

Today's group turned to their rescue (albuterol) inhaler about half as often as the group from the '90s did, and their lung function scores were higher. They also required less intubations than did children in the past -- 13 percent versus 21 percent.

"The medication playing the greatest role in this improvement to date is inhaled corticosteroids," said Dr. Alissa Hersh, an assistant clinical professor in the division of allergy and immunology at Morgan Stanley Children's Hospital of New York-Presbyterian in New York City. "If we can keep them on preventive medications, we can keep them from having acute exacerbations."

Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital in Detroit, agreed that inhaled steroids are the most effective first-line treatment. However, she also pointed out that the U.S. National Institutes of Health first issued their asthma management guidelines in the mid-'90s, and she said that guidance has likely played a role in improved asthma management as well.

Appleyard said she wished the authors had also looked at hospitalization and death rates to see if there were any differences.

"Newer medications are much more effective in treating people with severe asthma, but this doesn't mean the battle is over. People are still dying from asthma," she said.

One problem may be compliance with the doctor's orders when it comes to taking medications. A second study that was expected to be presented at the same meeting found that even when people have insurance, and they have a regular doctor, they may not always follow their asthma management plans. The study found that about one in four children with insurance were using inhaled corticosteroids while just one in five uninsured children were. The published study information did not identify the severity of the asthma.

Another study, this one from the Agency for HealthCare Research and Quality, suggests that insurance status does affect compliance. This study found that 30 percent of those with insurance were taking preventive asthma medications, while only 18 percent without insurance were on the drugs.

"We've made a significant impact on asthma management, and we're definitely moving in the right direction," said Hersh, who added, "The ultimate goal is not just to prevent asthma, but ultimately to find a cure."

More information

Learn more about asthma treatments from the U.S. National Heart, Lung, and Blood Institute.

Posted: March 2009


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