A New Way to Treat Severe Asthma?

Asthma is an extraordinarily complex, simple disease.  By that, I mean identifying its cause and proper treatment is often harder than diagnosing the disease itself.  Patients with the more severe spectrum of disease are even more challenging, and may require asthma specialists to re-examine our own dogma by using innovative ways to use common medications.  Using combination inhalers as rescue medication may be one way to do this as this study from Lancet suggests.  However, this therapy is not for everyone with asthma, and is not without risk.  Dr. Susarla

Single Combined Asthma Inhaler Better Than Recommended Treatment

Using two asthma medications combined in a single inhaler provides superior rescue and preventive treatment than guideline-based treatments among adults whose asthma symptoms are not well controlled, according to two large, randomized clinical trials that were published in The Lancet Respiratory Medicine.

This new therapy is known as SMART (Single Inhaler Maintenance and RelieverTherapy).

The findings in these two studies challenge national (USA) and international asthmaguidelines, especially in the United States, where this combined inhaler approach has not yet been approved.

The authors added that the two-medications-in-one inhaler is safe and well tolerated.

As background information, the researchers explained that most adults with asthma do not manage to achieve good control of symptoms, despite effective drug treatment options. A survey of 1,000 asthma patients found that controller drugs are not used by nearly half of all adults and children with persistent asthma.

Medical guidelines advise doctors to prescribe corticosteroids (ICS) plus rapid-onset long-acting β2 agonist (LABA) combination inhaler to achieve control, together with a second short-acting β2 agonist (SABA) inhaler for rescue usage, for the treatment of symptoms.

SMART, on the other hand, uses only a single ICS/LABA inhaler for both relief and preventive treatment.

First Study - Europe

The first study involved 1,714 adults patients with moderate, persistent asthma from 14 different European countries. The study found that the patients in the SMART beclometasone/formoterol combination had a considerably smaller risk of severe asthma attacks, being hospitalized, or requiring urgent care compared to those receiving current best practice.

The authors said:

"We believe that the additional cost of inhaled corticosteroid and rapid-onset, long-acting β2 agonist combination (29 Eurocents per patient per day) is justifiable because of the significant reduction in severe exacerbations, and specifically hospital admissions, known to have a huge effect on health-care costs in asthma."

Read article here.