Asthma Pills Work as Well as Inhaled Steroids:
WEDNESDAY, May 4 (HealthDay News) -- In a study that compared
asthma pills against commonly prescribed inhaled steroids, British
researchers found that the oral medications were as effective as
the inhaled drugs.
The oral medications, known as leukotriene-receptor antagonists,
"have shown similar efficacy and cost and better compliance, and
should be considered for any patient, not as a last option but as
an option for any patient," said study co-author Dr. Stanley
Musgrove, a senior research associate at the University of East
Anglia in Norwich.
"Every different patient will have their own issues that are important to their care: their compliance to different medications, how well they feel that different medications work for them, their concerns about different medications, any possible minor side effects, etcetera, and all of those should be considered when the clinician and the patient are making a decision about the best medication," he noted.
Results of the study are published in the May 5 issue of the
New England Journal of Medicine.
The study was designed to be what the researchers call a
"pragmatic" trial, which more closely mimics the way people use
medications in real life as opposed to the strict rules of a
clinical trial, according to Musgrove.
The researchers recruited 650 people with mild to moderate
asthma. The study volunteers were between the ages of 12 and 80,
and had inadequate asthma control or an impaired quality of life
due to asthma symptoms.
Volunteers were randomly assigned to a group. One arm of the
study compared leukotriene-receptor antagonists (Accolate and
Singulair) to inhaled corticosteroids as a first-line treatment for
asthma. The other arm of the study compared people who were already
taking inhaled steroids who then added on either a long-acting
rescue medication (known as a LABA) or leukotriene-receptor
Patients were allowed to comply as they wanted to and change
medications as they needed to, Musgrove said.
The results at two months suggested that LTRAs were similarly
effective to inhaled corticosteroids when used as a first-line
treatment and to LABAs when used as an additional treatment. After
two years, the effectiveness of both treatments was similar but
researchers noted that "equivalence was not proved."
The main measure of the medications' effectiveness was the Mini
Asthma Quality of Life Questionnaire. This 15-item quiz has total
scores ranging from 15 to 105, with the higher scores indicating
less asthma impairment. Scores increased by an average of 0.8 to 1
point in both arms of the trial. Asthma control and the frequency
of asthma exacerbations was similar among the groups.
Musgrove said there were no significant side effects reported
for any of the medications. However, in 2009, the U.S. Food and
Drug Administration requested that the makers of LTRA medications
add a warning to their drug labels because of serious behavioral
side effects, including suicidal thoughts and depression in some
people taking the medications.
The risks of inhaled steroids for asthma include hoarseness,
thrush, sore throat, and possibly reduced bone density.
In terms of costs, a 2010 United Kingdom study that compared the
costs of the two therapies for initial asthma control found that
the price of LTRAs was "significantly higher" than that of inhaled
One expert said the most recent study comparing the
effectiveness of LTRAs and inhaled steroids underscored the need
for individualized therapy.
"These study findings don't make me change my mind. It confirms that there are various options, and there's not one answer for everyone," said Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital and Medical Center in Detroit.
"The National Institutes of Health has issued guidelines on managing asthma, and a lot of literature review went into setting up those guidelines that recommend trying inhaled corticosteroids first. And, it's been my experience that I get good control with more patients using inhaled corticosteroids," she said.
"But if someone is having trouble using an inhaler regularly or they're having side effects, then I would think about changing their medication," she added. "But, there's no one medication that will help everyone, and no medication is without risk."
Learn more about asthma medications from the
American Academy of Allergy, Asthma and
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