The Year in Asthma
PHILADELPHIA -- Asthma mortality rates are declining worldwide, largely due to increased use of inhaled corticosteroids to manage the disease. That was the conclusion of an international group of researchers, who presented data on world trends at a 2006 meeting here.
PHILADELPHIA, Dec. 28 -- Asthma mortality rates are declining worldwide, largely due to increased use of inhaled corticosteroids to manage the disease. That was the conclusion of an international group of researchers, who presented data on world trends.
The following summary reviews some of the highlights of the year in asthma research. For fuller accounts, links to the individual articles published in MedPage Today have been provided.
Mortality
Despite the decline in mortality reported at the 2006 annual meeting of American College of Asthma, Allergy & Immunology, asthma still accounts for one of every 250 deaths worldwide, many of which could have been prevented with better medical care.
Corticosteroids
One element that may presage better care in poorer areas is the advent of generic corticosteroids. The FDA approved the first this year - a generic version of Flonase (fluticasone propionate) - and more are in the pipeline, a Chicago researcher said, noting the price difference for a one-month supply was substantial.
Corticosteroids remain the gold standard for treating asthma, despite options such as Intal (sodium cromoglycate), according to a review published by the Cochrane Collaboration. Intal, a non-steroidal inhaler, can be used, the review said, but the corticosteroids let adults and children breathe easier. The finding supported the consensus in the medical community.
On the other hand, two randomized trials this year showed that pre-emptive use of corticosteroids in childhood does not prevent the later development of asthma. In some kids, the drugs controlled persistent or severe wheezing - thought to be a precursor to later asthma - but researchers on both trials said there was no evidence they prevented the disease. And, given that the drugs are not risk-free, they cautioned that children under the age of two should be given corticosteroids carefully.
Ketek
The antibiotic Ketek (telithromycin) improved recovery from an acute asthma attack by three days, reduced symptoms, and improved hospital-based lung function measurements, researchers in London said. However, the drug, a member of a new class of antibiotics, had no effect on peak expiratory flow.
Smoking
Smoking and asthma don't go together - or at least they shouldn't. But when smokers with asthma quit, they get an immediate bang for the buck - an improvement in lung function by 15.2% within six weeks. In fact, even after a week off cigarettes, there was a noticeable improvement in lung function, according to researchers in Glasgow.
Overeall Costs
Chronic obstructive pulmonary disease (COPD) is the only disease in the top 10 that's on the rise, and it's not coming cheap. Healthcare costs associated with COPD are expected to top billion over the next 20 years, reported investigators at the annual meeting of the American Thoracic Society. Although smoking rates are falling, the researchers said, associated pathology, such as COPD, takes years to develop and will continue to rise.
Overall Care
But even now, when costs are relatively low, patients with asthma and COPD get only half the care that they should, according to a national sample reported in the journal CHEST. Overall, study participants received only 55.2% of recommended care for COPD and asthma patients received 53.5% of recommended care.
Combo
Even standard COPD care can be improved, as researchers found when they investigated the combination of Flovent (fluticasone propionate) and Serevent (salmeterol) in a single formulation. The combination of the drugs - usually used alone --- increased survival, quality of life, and lung function. Compared with placebo, the combination resulted in a 17.5% relative risk reduction in all-cause mortality over three years.
Smooth Faces
And finally, British researchers have found that middle-age smokers with heavily wrinkled faces are five times more likely to develop COPD than smooth-faced smokers. Exactly why remains unclear, although the researchers think both wrinkles and COPD may be a function of some underlying susceptibility, triggered by tobacco.
