FDA Approves Breo Ellipta, Once-Daily LABA/ICS for COPD The FDA approved the new drug Breo Ellipta as a once-daily inhaled therapy for chronic obstructive pulmonary disease (COPD). Breo Ellipta includes the corticosteroid fluticasone, and vilanterol — a once-daily long acting beta agonist — in a combination dry powder inhaler. This was the FDA’s first approval [... read more]
Daily Inhaled Steroids Stunt Kids’ Growth, Study Shows If you’re a half-inch shy of six feet, the next time you’re getting your jump shot blocked by your non-asthmatic friend, you can blame the inhaled corticosteroids your Mom made you take as a kid. Studies have consistently showed children’s height slows down for a few years [... read more]
Consensus guidelines advise that patients with regular symptoms of asthma should take inhaled corticosteroids every day, and when they’re having poor asthma control, they should tell their doctor, who can increase the steroid dose or add other “step-up” therapies. But asthma symptoms vary daily and can worsen at any time. And it can be hard [... read more]
Spiriva (Tiotropium) for Uncontrolled Asthma Most people with asthma can achieve good control with inhaled corticosteroids (ICS) and a long-acting beta-agonist (LABA). Some people living with asthma, though, experience persistent symptoms despite maximum doses of these inhaled medications. Fairly or not, LABAs have also been sullied with an FDA black-box warning for worsening bronchospasm in a [... read more]
Proton Pump Inhibitors No Help for Kids’ Asthma Gastroesophageal reflux (GER) is a mysterious co-conspirator with asthma. Many people with uncontrolled asthma have reflux (either symptomatic by history, or asymptomatic and detected on esophageal pH studies). Randomized trials in adults suggest that treating symptomatic GERD (gastroesophageal reflux DISEASE) improves asthma, but treating asymptomatic GER does not [... read more]
Smoking marijuana moderately over years is strongly associated with small improvements in lung function, even compared to people who have never smoked cigarettes or marijuana, according to a study in JAMA. But the popular news media and the study authors downplayed that finding of the study, apparently to avoid sending a pro-marijuana message. Mark Pletcher, [... read more]
Just How “Dangerous” Are Long-Acting Beta-Agonists, Really? Gustavo Rodriguez and Jose Castro-Rodriguez reviewed 20 systematic reviews and databases reporting on the incidence of adverse events with long-acting beta-agonist (LABA) therapy for asthma, for the April 2012 Thorax. They conclude the following: LABAs as monotherapy significantly increase the risk for adverse effects and bad outcomes from [... read more]
Chronic cough is the scourge both of the coughers themselves, and the doctors who treat them. Although rarely medically serious, chronic cough can be surprisingly debilitating by disrupting sufferers’ social and professional lives — church, piano recitals, and business meetings are a few situations that involuntary coughing can mess with your mojo. Doctors, for their [... read more]
The FDA announced earlier this month that it granted approval to 10 generic manufacturers to produce and market generic forms of montelukast, sold by Merck since its approval in 1998 as Singulair. Brand-name Singulair currently costs about $168 per month, so cost competition could bring considerable savings to those taking the medication (and their insurance [... read more]
(image: GE) Exhaled Nitric Oxide Analysis for Respiratory Disease: ATS Guideline A blue ribbon panel led by Raed Dweik releases this ATS practice guideline, recommending when & how to use exhaled nitric oxide (FE-NO) for use in diagnosing and treating inflammatory respiratory conditions. FE-NO’s uses, they say, include: Predicting responsiveness to corticosteroid therapy Helping diagnose [... read more]
(image: flickrCC) Why do we test chronic obstructive pulmonary disease (COPD) patients for bronchodilator responsiveness (besides getting to charging a few extra bucks for it)? If I am reading this article right, the answer is, there’s no good reason. Consider this: Bronchodilator responsiveness (BDR) or the lack thereof does not distinguish COPD from asthma. Bronchodilator [... read more]
(image: flickrCC) Is acetaminophen responsible for the worldwide rise in childhood asthma over the past 30 years? Citing a mounting pile of circumstantial evidence from epidemiologic observational studies, John McBride of Akron’s Children’s Hospital in Ohio believes so, and that it’s time to officially push the worry button. The theory is that the fear of aspirin-induced [... read more]
(image: nict.budocentral.com) Air pollution exposure seems to worsen lung function, and low-income children seem particularly vulnerable. One proposed reason for their susceptibility is co-exposure to high parental stress, which is worse in low-income families. Although that may sound hokey, psychosocial stress has been shown to increase oxidative stress, airway inflammation, and steroid resistance. (These findings [... read more]
(image: flickrCC) Health insurance plans are shifting an increasing portion of costs for prescription medications onto patients. A recent study in JAMA concluded that such cost shifting decreased asthma medication use and increased hospitalization rates in U.S. children. But the effect, if real, was small. What They Did Pinar Karaca-Mandic et al looked back at [... read more]
Bronchial Thermoplasty for Refractory Asthma Update Even with maximal treatment with medications, some patients with severe asthma remain symptomatic with impaired lung function and quality of life. Bronchial thermoplasty is a new treatment approved by the FDA in 2010 as a therapy for severe asthma not controlled by inhaled corticosteroids and long-acting beta agonists. Bronchial thermoplasty essentially [... read more]
(Comments by first author James T. Good follow this post.) For 58 patients with refractory asthma at National Jewish, James Good et al devised a systematic, bronchoscopy-driven approach that they feel resulted in improved asthma symptoms and identification of potential phenotypes of refractory asthma among the enrolled subjects. Their methodology was highly detailed and time- and labor-intensive. It included using [... read more]
Can someone tell me why asthma gets no respect in academic pulmonology? I repeatedly hear otherwise intelligent physicians call asthma “boring,” as if we’ve conquered the disease (or maybe they think they have). In fact, severe asthma is a perenially humbling adversary that has proven largely resistant to a decades-long onslaught by both Pharma and the NIH. Severe asthma is a common cause of severe disability [... read more]
GlaxoSmithKline has a new once-daily inhaled corticosteroid called fluticasone furoate; it has enhanced affinity for glucocorticoid receptors and a longer duration of action compared to the commonly-used fluticasone propionate, which must be taken twice daily to achieve a steady bioavailable concentration. In the January Thorax, William Busse et al report the findings of a Phase [... read more]
Allergic rhinitis is mostly just an annoyance for 400 million people worldwide, but the condition can predispose to frequent upper respiratory infections, and worsen asthma; Alexander Greiner et al tell you what you need to know in this review in Lancet. Incidence peaks in the teenage years. The nasal inflammation of allergic rhinitis synergizes with [... read more]
In July 2011, FDA approved indacaterol, Novartis’s new once-daily long-acting beta agonist, for the treatment of chronic obstructive pulmonary disease. In contrast to its European counterpart (EMA), which approved indacaterol there at doses up to 300 mcg, FDA only approved indacaterol in the 75 mcg daily dose. The FDA’s Badrul Chowdhury explains why in the [... read more]