Asthma

What's new in asthma?

Asthma, a disorder of the lungs and airways, is generally characterized by

• chronic inflammation
• airway hyperresponsiveness
• recurrent episodes of wheezing, coughing, chest tightness and breathlessness
• reversible airway obstruction

New therapies

The goal of asthma treatment is to avoid triggers and control airway inflammation.

• June 2010: Dulera (mometasone furoate/formoterol fumarate dehydrate; Merck) was FDA approved as treatment for asthma partially based on the results of two randomized clinical trials involving 1509 patients ≥12 years of age with persistent asthma uncontrolled on medium- or high-dose inhaled corticosteroids (ICS).
• August 2011: Verona Pharmaceuticals reported positive results from a phase II trial of RPL-554 for the treatment of mild asthma. RPL-554 is a novel, long-acting inhibitor of phosphodiesterase (PDE) 3 and PDE 4 enzymes, which combines bronchodilator and anti-inflammatory actions in a single drug.
• May 2012: Pulmatrix announced study results showing that iCALM (inhaled cationic airway lining modulator therapy) attenuated allergen-induced asthmatic bronchitis.

Update on diagnostic methods

Spirometry and peak expiratory flow rate remain standard methods for diagnosing asthma; however, for patients with asthma symptoms and normal lung function, measurement of airway responsiveness by methacholine challenge or nitric oxide tests may help establish diagnosis.

• Recent studies have shown that as many as 65% of general pediatricians do not use spirometry in routine asthma care, leading to the recent development of online training programs for this modality.
• Current guidelines for the management of asthma suggest extra measures may be required to diagnose asthma in children under age 5, in the elderly, and in cases of occupational asthma.
• A recent study suggests that the methacholine challenge test is not sensitive enough to rule out a diagnosis of asthma in Caucasians and in those without allergy.

Management challenges

Evidence for asthma management is based largely on studies carried out in adults. As researchers respond to a need for asthma studies in children, new management trends and challenges arise. For example, according to recent literature:

• Use of preventative asthma medication (ICS, leukotriene receptor antagonists, long-acting beta2-adrenergic agonists, mast-cell stabilizers, and methylxanthines) has increased among children with current asthma in the US from 1998 to 2008
• Inhaled anticholinergics may be associated with an increased risk of arrhythmias among children and young adults
• Results showing the superiority of ICS to 5-lipoxygenase inhibitors and leukotriene receptors antagonists in adults and children with persistent asthma, particularly in those with moderate airway obstruction, support current guideline recommendation that ICS remain the preferred monotherapy
• An NHLBI study reported that all children with mild persistent asthma benefit from ICS, but some demographic and clinical characteristics predict a greater benefit to ICS treatment for reduction of risk of asthma attack
• Many children failing ≥Step 4 asthma therapy may have severe asthma with fungal sensitization

Costs

The Asthma and Allergy Foundation of America estimates the annual cost of asthma at almost $18 billion. Asthma is the:

• fourth leading cause of missed work among adults
• leading cause of school absences from a chronic illness among children ages 5-17