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Nonsteroidal Asthma Drugs Fall Short

Study finds inhaled steroids better at easing flare-ups and symptoms

THURSDAY, March 20, 2003 (HealthDayNews) --People with mild to moderate asthma might want to stick with steroids rather than switch to nonsteroidal drugs.

That's the suggestion from Canadian researchers who found the latter medications are less effective for this group.

Many people concerned about the effects of steroids over the long term have switched to the nonsteroidal medications to control their asthma. Like steroids, the newer drugs, called leukotriene receptor antagonists (LTRAs), aim to reduce swelling and inflammation of the nasal passages.

However, McGill University Health Centre professor Dr. Francine Ducharme found that adults who took the alternate drugs were 60 percent more likely to suffer worsening of symptoms, including more asthma flare-ups, night awakenings, and more days with symptoms.

"If someone takes the standard dose of an inhaled glucocorticoid, switching to leukotriene receptor antagonists would probably bring less asthma control," says Ducharme, whose study appears in the March 22 issue of the British Medical Journal. "They would have more flare-ups and night-waking episodes."

In this country, some common brand names of inhaled steroids are Flonase, Flovent, Beclovent and Vancenase, while commonly prescribed LTRAs are Singulair and Accolate.

The LTRAs have become very popular in the United States, accounting for 30 percent of the anti-asthmatic drug market, compared to only 10 percent in Canada and the United Kingdom, says Ducharme. This is due partly to different marketing patterns in the different countries, but also because of the concern here about long-term use of steroids.

"The steroids are pretty safe, but people still have that concern in their minds. The aversion to steroids is much more in the States than elsewhere," she says.

For her study, Ducharme and her colleagues reviewed 13 studies involving approximately 5,000 people who suffered from mild to moderate asthma and took either the inhaled steroids or the LTRAs, which are taken in pill form. Asthma levels are defined by pulmonary lung function, with a lung function of 80 percent or better considered mild, and a lung functioning between 50 and 80 percent of full capacity diagnosed as moderate asthma.

Only one of the studies was of children, and included data on 124 children who were an average of 10 years and who were diagnosed with mild asthma. Although the results were the same for this study as for the adult studies, Ducharme says the numbers in this study were too small to make statistical conclusions on the effects of the two drugs on children.

"There is an urgent need for pediatric studies," she says.

Overall, those in the studies who took the anti-leukotrienes were 60 percent more likely to experience flare-ups that required taking systemic glucocorticoids than were those on the inhaled glucocorticoids. Further, those on the inhaled steroids showed significantly greater improvement compared to the other group in breathing in the morning, in having less awakenings at night, and fewer days with symptoms.

However, the maker of one of the LTRAs says the study was incomplete.

"From our initial, brief review of this paper, we note that it may not include all the data available to thoroughly compare LTRAs and inhaled glucocorticoids," said Lynn Kenney, a spokeswoman for Merck and Co., which makes Singulair.

More information

A thorough explanation of asthma can be found at National Institute of Allergy and Infectious Diseases. Test your knowledge of asthma by taking this quiz from U.S. Environmental Protection Agency.

SOURCES: Francine Ducharme, M.D. assistant professor, pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal; Lynn Kenney, spokeswoman, Merck & Co., Whitehouse Station, N.J.; March 22, 2003, British Medical Journal
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