SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

10/29/04

Comparison of different pharmacotherapies to reduce acute asthma exacerbations

Summary
Background - Several new approaches to asthma pharmacotherapy (AP) have been developed in recent years. How do they compare in reducing the frequency of acute asthma exacerbations (AAE)?

Findings - Sin et al of the Univ. of British Columbia in Vancouver carried out a systematic review and meta-analysis dealing with this question, reviewing published reports from 1/1/80 to 4/30/04. In reviewing double-blind trials of at least 3 months, the authors found that inhaled corticosteroids (ICS) were most effective, reducing the frequency of AAE by 55% as compared with asthmatics treated with placebo or just short acting beta agonists (p<0.001). Monotherapy with long-acting beta agonists (LABA) reduced AAE frequency by 25% with fairly considerable heterogeneity among studies. More impressively, the addition of LABA to ICS therapy was associated with an additional 26% reduction in AAE frequency above that achieved by ICS as monotherapy. Fewer AAE exacerbations occurred during this ICS/LABA combination therapy than with higher doses of ICS used as monotherapy. Leukotriene antagonist (LA) therapy was associated with a 41% reduced frequency of AAE but was less effective than ICS treatment. Use of monoclonal anti-IgE was associated with 45% fewer exacerbations.

Reference
JAMA 2004;292:367-76

Editor's Comments
The findings in this meta-analysis suggest that chronic treatment with one of several agents can significantly reduce the frequency of AAE with ICS somewhat more effective than LA in this regard. It is of particular interest that the addition of a LABA agent to ICS was associated with a significantly greater prevention of AAE. Although the combination of ICS and LABA leads to improved asthma control, several studies have shown that chronic use of LABA leads to increased bronchial reactivity. Therefore, such treated patients may be more susceptible to AAE triggered by irritants, viral infections, etc.

 

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