Assessment of various second-line medications in addition to inhaled corticosteroid in asthmatic patients - A randomized controlled trial.

Clin Exp Pharmacol Physiol. 2014 Apr 17;

Authors: Mg R, Ad N, K I

Abstract
Many patients with persistent asthma could not achieve the treatment goal for asthma with a single controller medication. The study aimed to assess the lung function and rescue medication usage in asthmatic patients receiving four different categories of drugs in combination with an inhaled corticosteroid. Recruited patients were randomized into four groups to receive Budesonide with Formoterol, Doxofylline, Montelukast and Tiotropium for a period of three months. Lung function i.e. Forced Expiratory Volume in one second (FEV1 ) and rescue medication usage was measured at baseline, day 15, 30, 45, 60 and 90. A total of 297 patients completed the study. At baseline, no significant difference (P>0.05) was observed in any of the outcome measures. Significant within-group improvement in% FEV1 was observed in all the groups. At day 90, between-group difference showed that improvement in% FEV1 was significantly (p<0.05) high for budesonide plus formoterol followed by budesonide plus montelukast, budesonide plus doxofylline and least for budesonide plus tiotropium. Similarly, within-group and between-group comparisons showed significant (p<0.05) reduction in rescue medication usage in all the groups. The intensity in decrease was more in budesonide plus formoterol group followed by budesonide plus montelukast, budesonide plus doxofylline and budesonide plus tiotropium groups. Based on our findings, among the second-line treatment regimens, budesonide with either montelukast or doxofylline was found to be better than budesonide plus tiotropium in mild to moderate persistent asthmatic patients. Further studies with a longer duration are likely to be useful. This article is protected by copyright. All rights reserved.

PMID: 24738981 [PubMed - as supplied by publisher]

Daily versus intermittent inhaled corticosteroid treatment for mild persistent asthma.

Curr Opin Allergy Clin Immunol. 2014 Apr 15;

Authors: Rodrigo GJ

Abstract
PURPOSE OF REVIEW: Guidelines recommend the use of daily inhaled corticosteroids as preferred treatment for preschoolers, children, adolescents, and adults with recurrent wheezing and mild persistent asthma. However, intermittent or as-needed inhaled corticosteroids treatment in response to symptoms is an emerging strategy. This review is focused on the analysis (clinical efficacy and safety) of this approach in comparison with the current daily-based therapy.
RECENT FINDINGS: Recently, some authors favored the use of inhaled corticosteroids based on symptoms. It has been suggested that a symptom-based approach could reduce the amount of drug used, minimize the risk of adverse events, and reduce healthcare costs. In contrast, physicians prescribing intermittent inhaled corticosteroids would give the wrong message to their patients about the chronicity of the disease. Currently, there is a significant body of high-quality clinical studies and systematic reviews that have addressed this important controversy, and whose analysis allows us to extract some important conclusions.
SUMMARY: Present evidence does not support a change in the direction of an intermittent or symptom-based use approach for recurrent wheezing and mild-to-moderate persistent asthma. At this point, there is no convincing basis to alter the current strategy to inhaled corticosteroids dosing, and more studies are needed comparing these two approaches.

PMID: 24739225 [PubMed - as supplied by publisher]

Effect of inhaled corticosteroids on systemic inflammation in asthma.

Perspect Clin Res. 2014 Apr;5(2):75-9

Authors: Karthikeyan R, Krishnamoorthy S, Maamidi S, Kaza AM, Balasubramanian N

Abstract
BACKGROUND: Recent research using serum high sensitivity C-reactive protein (hs-CRP) has evidenced existence of low grade systemic inflammation in asthmatics whose correlation with various clinical indices is not fully studied.
OBJECTIVE: To investigate the relationship between systemic inflammation and various clinical and treatment characteristics of asthma.
MATERIALS AND METHODS: Forty asthmatics (22 steroid inhaling and 18 steroid naïve) and 40 healthy subjects matched for age and sex were examined cross-sectionally. Along with clinical assessment, serum hs-CRP levels were measured for all subjects using latex enhanced immunoturbidometry method.
RESULTS: Serum hs CRP levels were significantly higher in steroid naïve asthmatics when compared to normal subjects (0.93 ± 1.18 vs 0.24 ± 0.31 mg/dL, respectively; Mann-Whitney U test, P < 0.001). This association persisted after adjusting for age, gender, body mass index (BMI), and socioeconomic status (adjusted odds ratio 10.47; 95% CI 1.88-58.3; P < 0.01). Steroid inhaling asthmatics had serum hs-CRP levels comparable with control group (0.17 ± 0.18 vs 0.24 ± 0.31 mg/dL respectively, P > 0.05). Among the clinical and treatment related variables, duration of inhaled steroids usage alone correlated significantly with serum hs-CRP levels (Pearson correlation coefficient r = 0.449, P < 0.05), which was independent of age, BMI, duration of illness, and frequency of emergency visits.
CONCLUSION: This study confirms the existence of low grade systemic inflammation in asthma which is effectively controlled by inhaled steroids. Such an effect of inhaled steroids appears to be more pronounced in recent users than that of long-term users, possibly due to lower adherence rate among the latter.

PMID: 24741484 [PubMed]