Ever had the sensation you can't breathe? No, not just short of breath but really unable to draw air into your lungs. It's a pretty scary feeling, speaking as someone with allergies that sometimes compromise my breathing, but for folks with asthma, such sensations are common, debilitating, may result in hospitalization or even death. And the number of people with asthma is growing.
The American Academy of Allergy, Asthma and Immunology cites 300 million as the number of people with asthma worldwide, with an estimate that by 2025 there will be another 100 million of them. The best way to treat asthma is therefore a huge public health issue, and this week's NEJM provides some answers.
Leukotriene receptor antagonists (listening to that with Rick's Texas twang is a real treat on this week's podcast) or LTRAs are examined in two parallel studies: one where the drugs are used as first line treatment and the other where they're used as add-on medications to an existing regimen. One of the really interesting aspects to these studies is one I'm betting we'll be hearing much more about. They're so-called 'pragmatic' studies. AKA, real world.
Researchers recruited everyone who had a physician's diagnosis of asthma and was willing to participate. This is in contrast to many study participants who are carefully selected, often intensively managed, and are likely not representative of the folks who will ultimately receive a drug or treatment under study.
These study subjects ranged in age from 18 to 80. About half of the 300 people who enrolled for the first line trial received LTRAs, with the other half receiving the guideline recommended treatment with inhaled steroid medication. As a add-on treatment, 350 patients were enrolled, about half of whom took LTRAs while the other half took another class of asthma medications known as long acting beta agonists (LABA). At two months, LTRAs were shown to be equivalent to the comparators for both studies. After two years of follow-up this equivalence could not be shown, but the authors speculate this may be due to crossover among the treatment groups and the lack of a placebo treated group.
There are significant advantages to LTRAs, as Rick points out in the podcast. They are once a day, oral medications, and people are much more likely to remember to take medications such as these rather than inhaled steroids that must be administered twice a day. And they'll soon come off patent, so generics will be available at presumably decreased cost. Clearly, getting a handle on how best to treat asthma in the real world is deserving of more studies such as this one.
Other topics this week include another in NEJM on , whether salt is really Darth Vader in JAMA, and a high rate of use of botanical supplements in infants in Pediatrics. Until next week, y'all live well.
Best Asthma Medications?,6 Comments