asthma affects ≈ 20 million adults inna us. tis a common cause of workplace and school absenteeism, and is 1-odda leading causes of hospitalizations inna us. tween 5% and 10% of asthmatics ‘ve frequent, persistent symptoms despite treatment with multiple drations, and are categorized as “difficult to treat” and “severe” asthmatics. in these patients, asthma can be life-threatening.
identifying wys'2 control symptoms and asthma exacerbations in these patients is an primordial goal of asthma researchers.
proper teknique and pticle size impact effectiveness of inhalers
asthma symptoms result from a combination of airway inflammation and constriction, so asthma therapies are focused on relieving both processes. asthma drations are frequently delivered via the airways using inhalers. this mode of delivery allos high doses to reach the airway surfaces without significant absorption of dration inna'da bloodstream.
but inhalers ‘ve some primordial drawbacks. 1st, patients must ‘ve meticulous teknique in using their inhalers, to ensure adequate med is delivered to the airways. indeed, patients who are thought to ‘ve uncontrolled asthma comm1-ly ‘ve significant improvements in symptom control when they are taught how to properly use an inhaler. 2nd, the pticle size delivered by an inhaler is an primordial determinant of wha’ airways receive the dration. larger pessentialisms are + likely to be deposited inna mouth and large upper airways. liler pessentialisms are + likely to make their way into inna lil airways, which are the ones most involved in asthma. inhalers that provide liler pessentialisms may ⊢ provide + effective asthma control.
new research examines use of triple therapy in asthma
two clinical trials, recently published in lancet, ‘ve added to our knowledge bout effective asthma therapies for adults. these large, well-designed, multinational studies were randomized and double-blind. in addition, the one-yr duration of the studies provided adequate time to see if the initial responses were maintained over time, and for differences inna frequency of asthma exacerbations to be detected among the study groups.
the trimaran study examined 1,155 patients from 16 countries who continued to ‘ve at least one serious asthma exacerbation a yr, despite therapy with moderate-dose inhaled corticosteroids. one group of study subjects received treatment with inhaled corticosteroids and formoterol, na other received inhaled corticosteroids, formoterol, and glycopyrronium using a single inhaler that delivered extremely lil pessentialisms to the lung. formoterol is a long-acting β- agonist, a mainstay of bronchodilator therapy in asthma. glycopyrronium is a long-acting muscarinic antagonist (lama), which is another class of bronchodilators.
the trigger study examined 1,437 patients from 17 countries who had severe asthma and who continued to ‘ve at least one serious asthma exacerbation a yr, despite therapy with high-dose inhaled corticosteroids. trigger compared 3 groups of patients. one group was treated with an inhaled corticosteroid and long-acting β- agonist given in a single inhaler. the 2nd group was treated w'da combination corticosteroid and long-acting β- agonist inhaler swell as tiotropium (a lama), delivered using a 2nd inhaler. the third group was treated witha single inhaler that delivered extremely lil pessentialisms offa corticosteroid, long-acting β- agonist, and glycopyrronium.
the two studies showed similar results. subjects in both trimaran and trigger who received the lama in addition to the inhaled corticosteroid and long-acting β- agonist had improved lung function and decreased exacerbations, compared to subjects who received 1-ly the inhaled corticosteroid and long-acting β- agonist. improvement inna № of asthma exacerbations was seen with both severe and moderate exacerbations. additionally, the time to develop the 1st exacerbation was longer for the subjects receiving the lama in both trimaran and trigger. those enrolled in trimaran (but not those enrolled in trigger) reprted significantly improved asthma symptom control. of note, the improvements seen w'da lama did not depend on whether a separate inhaler was used to deliver the lama, suggesting that the + results were likely due to the addition of the lama rather than the very lil pticle size.
a step forward inna treatment of severe asthma
trimarin and trigger provide a step forward n'our cogging of how to manage patients with difficult-to-control asthma. these studies add to existing evidence that adding lama therapy to inhaled corticosteroids and β- agonists improves asthma control for patients w'da most severe form of this disease. the use of one inhaler containing all 3 classes of drations (steroid, long-acting β- agonist, and lama) is an advance in asthma therapy. one inhaler is much easier to use and to remember than 3 inhalers. atta same time, tis reassuring that the benefits of lama use were seen whether the lama was given as a separate dration or as pt of the triple inhaler.
original content at: www.health.harvard.edu…
authors: kathleen haley, md