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Asthma Studies: Drug Combos Help

November 12, 1997

Modest doses of inhaled steroids combined with other drugs control asthma as well as or better than high doses of steroids, while reducing the risk of side effects from long-term use, two studies found.

Steroids reduce the frequency of asthma attacks. But daily use over a few years has been linked to osteoporosis and cataracts in older adults and slowed growth in children. And the effects over decades of use are unknown because the drugs are so new.

Two studies published in Thursday’s New England Journal of Medicine looked at drug combinations that might allow asthma sufferers to get by with lower doses of steroids.

``Taking two medications in modest quantities seems to improve control of the disease while reducing the possible long-term side effects,″ said Dr. Gilbert D’Alonzo, a professor of medicine at Temple University in Philadelphia who was not involved in either study.

Asthma afflicts 14 million to 15 million Americans, causing thousands of emergency hospitalizations and killing more than 5,000 people a year.

Inhaled steroids _ the first-line approach to treating moderate or severe asthma _ reduce the chronic lung inflammation that makes it hard for patients to breathe.

One of the studies looked at formoterol, an inhaled airway-relaxing type of drug known as a long-acting beta-2-agonist, in combination with the inhaled steroid budesonide. The study, led by Dr. Romain Pauwels at University Hospital in Ghent, Belgium, involved 852 patients ages 17 to 70 at hospitals in Europe and Canada.

After a year of treatment, patients getting formoterol and low doses of budesonide had fewer symptoms, better lung function and more asthma attack-free days than those getting moderate doses of budesonide alone. However, the higher dose of budesonide was more effective at preventing the most severe asthma attacks.

The combination of formoterol and a moderate dose of budesonide proved to be the best treatment of all.

In the other study, researchers from the Imperial College School of Medicine in London compared patients treated with high doses of budesonide with those getting a moderate dose of budesonide plus theophylline pills. Theophylline is known as a bronchodilator; it relaxes the airways.

The combination treatment was just as effective as high-dose treatment with the inhaled steroid alone, and was considerably cheaper: $60 per month, compared with $100 for the high dose of budesonide or $155 for a combination of moderate-dose budesonide and a beta-2-agonist called salmeterol.

Formoterol is available in Europe but is still awaiting Food and Drug Amdministration approval in the United States. Salmeterol is the only long-acting beta-2-agonist approved by the FDA. It has shown similar results when used in combination with an inhaled steroid, D’Alonzo said.

There are two distinct types of beta-2-agonists: Short-acting beta-2-agonists, such as albuterol, are used for quick relief during an asthma attack. Long-acting beta-2-agonists are taken twice a day to prevent attacks but do not help during acute episodes because they are slow to take effect.

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