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What is new in the treatment of asthma


What is new in the treatment of asthma

An asthma attack occurs when a person that suffers from asthma is contacted by an asthma trigger, something that causes an irritations in his respiratory system.

During this attack, all the muscles around the airways are stressed causing the airways to be narrower and the inner lining of the airways to become inflamed. Sometimes sticky mucus or phlegm builds up which can further narrow the airways. The result of all these reactions is the irritation and the ightening of the airways, causing difficulty in  breathing and leading to asthma symptoms.

 

The treatment options for Asthma in general are as follows :


1- Long – term control medications: they include

  • Inhaled corticosteroids: fluticasone, budesonide, mometasone, flunisolide, beclomethasone, and others.
  • Leukotriene modifiers: like montelukast , zafirlukast and zileuton.
  • Long – acting beta agonists (LABAs ): like salmeterol and formoterol.
  • Combination inhalers: such as (fluticasone and salmeterol ) and (budesonide and formoterol).
  • theophylline.

 

2- Quick – relief medications: they include

  • Short – acting beta agonists: albuterol, levalbuterol and pirbuterol.
  • Ipratropium.
  • Oral and intravenous corticosteroids: like prednisone and methylprednisolone.

 

3- Treatment for allergy – induced asthma:

  • Allergy shots (immunotherapy).
  • omalizumab.
  • Allergy medications : these include oral and nasal spray antihistamines and decongestants as well as corticosteroids, cromolyn and ipratropium nasal sprays.

 

4- Bronchial thermoplasty.


Some trials, studies, researchers related to the subject:

 

1- A short course of steroids reduce relapse:

This updated finding was drawn after reviewing data in six trials that involved 375 people at the University of Alberta, Edmonton, Canada in July 2007.


Between 12% and 16% of people who are discharged from hospital after having an asthma attack have a relapse within two weeks. This systematic review strongly supports the use of systemic corticosteroids for treatment of outpatients who leave hospital after an asthma attack. In addition to reduce the chance of a relapse, this course also reduces the use of inhalers. the benefit lasts for about three weeks.


2- Combo inhaler might simplify treatment for asthma:
People suffering from chronic asthma might have a new treatment option that allows them to manage their condition with a single prescribed inhaler that contains two medicines, according to a new systematic review appears in the current issue of the Cochrane Library in april 2009.
The researchers has been investigating the use of both a low – dose corticosteroid (budesonide) and beta2 – agonist (formoterol) in a single inhaler. the review compares the effectiveness of the new inhaler to the current best practice of separate inhalers for different phases of asthma treatment.


3- New asthma treatment options developed:

People with mild well – controlled asthma with twice daily use of inhaled steroids may be able to reduce inhaler use to once daily or switch to a daily pill according to new research conducted at Wake Forest University Baptist Medical center and 20 other centers, and the results are reported in the May 17 issue of the New England Journal of medicine in 2007.


The study involved 500 children and adults whose asthma was treated with twice- daily inhaled fluticasone. study participants were randomly divided into 3 groups : one continued to take fluticasone twice daily for 16 weeks , the second group took a combination of fluticasone and salmeterol in a single inhaler once daily, the third group took the oral medication montelukast once daily.


The study then measured rates of treatment failure among the three groups which included hospitalization or urgent medical care, or the need for additional medications or decline in lung functions. The first and second groups had a treatment failure rate of 20% and in the third group the rate was 30%.


This study suggests that patients whose asthma is well controlled on twice – daily fluticasone can be switched to once – daily fluticasone\salmeterol without increased rates of treatment failure.


4- Possible alternate therapy for adults with poorly controlled asthma:
According to a study involved 210 patients and its results were published in the New England Journal of Medicine in sep 2010 and presented at the annual congress of the European Respiratory Society in Barcelona, Spain.


This study's results show that tiotropium bromide might provide an alternative to other asthma treatments, and adding this drug to low doses of inhaled corticosteroids is more effective at controlling asthma than doubling inhaled corticosteroids alone, and as effective as adding the long – acting beta agonists salmeterol.


Tiotropium relaxes smooth muscle in the airways through a different mechanism than beta agonist, and thus may help people who do not respond well to currently recommended treatments.


5- Potential cancer drug may offer new hope for asthma patients:

Scientists at the university of Edinburgh found that the drug -R- roscovitine helps to kill certain immune cells known as eosinophils.


Too many uncontrolled eosinophils can damage cells that line the lung, contributing to inflammatory conditions such as asthma.


Researchers found that the use of the drug caused the eosinophils cells to undergo a form of cell death known as apoptosis, a natural process where unwanted cells are removed from the body.


The research has been published in the journal FEBS letters in dec 2009.


6- Experimental nonsteroidal treatment of asthma shows promise:
A new NSAI therapy made from a human protein significantly decreases disease signs of asthma in mice, opening the possibility of a new asthma therapy for patients who do not respond to current steroid treatments.


The protein, insulin – like growth factor binding protein – 3 ( IGFBP – 3 ), uniquely inhibits specific physiological consequences of asthma examined in asthmatic mice. IGFBP – 3 targets a key cellular pathway called nuclear factor kappa B, or NF-k B that plays a role in inflammation. The IGFBP- 3 protein interferes with its cellular signaling and suppresses NF-Kb activity. The treatment reduced all physiological manifestations of asthma including airway inflammation and hyperactivity.


Results of this therapy were presented at the endocrine Society's 92 nd Annual Meeting in San Diego in July 2010.


7- Vitamin supplement could help treatment – resistant asthma:
Researchers from King's College London have found that in asthma patients who do not respond to steroid treatment , their responsiveness could substantially improved by adding vitamin D3 to their treatment list.


The steroid treatment works by inducing T – immune cells to synthesise a secreted signaling molecule, called TL – 10 which can inhibit the immune responses that cause the symptoms of asthma. T – cells taken from patients who are steroid resistant do not produce IL – 10 when cultured in vitro with dexamethasone.


The researchers found that when vitamin D3 was added to the culture medium with dexamethasone, this defect was reversed and the previously steroid – resistant cells were able to respond to the treatment by producing IL – 10 to the same extent as T – cells taken from steroid – responsive patients.


These results were published in the Journal of clinical investigation in DEC 2005.


8- Interferon might help asthma patients breathe easier:
UT Southwestern Medical Center Researchers have found that the protein interferon blocks the development of a class of T – lymphocytes called T – helper 2 cells, or TH2 cells known to cause asthma symptoms. in details, researchers in this study showed in isolated human cells that interferon blocks the development of nascent TH2 cells and inhibits cells that already have become TH2 cells by interfering with a regulatory protein called GATA3, a transcription factor TH2 cells express to regulate their function.


This study was published in the Journal of Immunology in July 2010.

 

9- Oral contraceptives may benefit women with asthma:
Researchers from Mc Master University in Hamilton, Canada studied women with asthma during their menstrual cycles. results showed that women not using oral contraceptives had higher mean exhaled nitric oxide (eNO) levels which is a marker of airway inflammation associated with asthma than women using oral contraceptives. Researchers speculate that oral contraceptives may have a potential role in the management of premenopausal women with asthma.


This study was published in the Journal of the American College of chest physicians in Nov 2009.


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Prepared by: Scientific Section


Source :

Science daily. com
Drugs. com






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