Triple remedy helps management extreme bronchial asthma – . Well being Weblog
Asthma affects approximately 20 million adults in the United States. It is a common cause of absenteeism from work and school and a leading cause of hospital stays in the United States. Between 5% and 10% of asthmatics have frequent, persistent symptoms despite treatment with multiple medications and are classified as "difficult to treat" and "severe" asthmatics. In these patients, asthma can be life threatening.
Identifying ways to control symptoms and asthma exacerbations in these patients is an important goal of asthma researchers.
The right technique and particle size will affect the effectiveness of inhalers
Asthma symptoms result from a combination of airway inflammation and narrowing. Therefore, asthma therapies focus on alleviating both processes. Asthma medications are often delivered through the airways using inhalers. This type of delivery allows high doses to reach the airway surfaces without significantly absorbing drugs into the bloodstream.
However, inhalers have several important disadvantages. First, patients must use their inhalers carefully to ensure that adequate medication is being supplied to the airways. In fact, patients believed to have uncontrolled asthma often have significant improvements in symptom control when taught how to properly use an inhaler. Second, the particle size released by an inhaler is an important determinant of which airways will receive the drug. Larger particles are more likely to settle in the mouth and large upper airways. Smaller particles are more likely to enter the small airways that are most commonly involved in asthma. Inhalers that deliver smaller particles may therefore provide more effective asthma control.
New research investigates the use of triple therapy for asthma
Two clinical studies recently published in the Lancet have expanded our knowledge of effective asthma therapies for adults. These large, well-designed multinational studies were randomized and double-blind. In addition, the one-year duration of the studies provided ample time to determine whether initial reactions persisted over time and to identify differences in the frequency of asthma exacerbations between study groups.
The TRIMARAN study examined 1,155 patients from 16 countries who, despite treatment with medium-dose inhaled corticosteroids, continued to have at least one severe asthma exacerbation per year. One group of subjects received treatment with inhaled corticosteroids and formoterol, and the other group received inhaled corticosteroids, formoterol, and glycopyrronium using a single inhaler that delivered extremely small particles to the lungs. Formoterol is a long-acting beta agonist, a mainstay of bronchodilator therapy for asthma. Glycopyrronium is a long-acting muscarinic antagonist (LAMA), another class of bronchodilators.
The TRIGGER study examined 1,437 patients from 17 countries who had severe asthma and who continued to have at least one severe asthma exacerbation per year despite treatment with high-dose inhaled corticosteroids. TRIGGER compared three groups of patients. One group was treated with an inhaled corticosteroid and a long-acting beta-agonist given in a single inhaler. The second group was treated with the combination of a corticosteroid and long-acting beta-agonist inhaler and tiotropium (a LAMA) administered using a second inhaler. The third group was treated with a single inhaler that delivered extremely small particles of a corticosteroid, a long-acting beta agonist, and glycopyrronium.
The two studies showed similar results. Both TRIMARAN and TRIGGER patients who received LAMA in addition to their inhaled corticosteroid and long-acting beta agonist had improved lung function and reduced exacerbations compared to subjects who received only the inhaled corticosteroid and long-acting beta agonists. An improvement in the number of asthma exacerbations was observed in both severe and moderate exacerbations. In addition, the time to develop the first exacerbation was longer for the subjects who received the LAMA in both TRIMARAN and TRIGGER. Those enrolled in TRIMARAN (but not those enrolled in TRIGGER) reported significantly improved control of asthma symptoms. Notably, the improvements observed with the LAMA did not depend on whether a separate inhaler was used to deliver the LAMA, suggesting that the positive results were due to the addition of the LAMA rather than the very small particle size.
An advancement in the treatment of severe asthma
TRIMARIN and TRIGGER are an advancement in our understanding of how to treat patients with difficult-to-control asthma. These studies complement existing evidence that adding LAMA therapy to inhaled corticosteroids and beta-agonists improves asthma control in those with the most severe form of the disease. Using an inhaler that contains all three classes of drugs (steroid, long-acting beta agonist, and LAMA) is an advancement in asthma therapy. One inhaler is much easier to use and remember than three inhalers. At the same time, it is comforting that the benefits of using LAMA have been seen, regardless of whether the LAMA was given as a separate drug or as part of the triple inhaler.
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