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Pulmonology News and Articles

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

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