Asthma: Advances in Medications this Decade
A cure for asthma is not likely. That's the bad news.
The good news is that asthma deaths have decreased and
advances in medications
over this decade
offer a chance for
prevention and control of this disease that affects more than 20 million people in America.
In this post I will discuss 5 emerging asthma treatments which have contributed (or will contribute) to improved asthma management.
Xolair (a brand of Omalizumab) This injection therapy became available in 2003 and has now been used in over 40,000 patients in the U.S. for treatment of severe asthma. The novel therapy for asthma treatment represents the first of its kind and has proven to be very effective for some asthma sufferers. Xolair is very expensive (over $1,000.00 a month) and requires a history of severe asthma. Before being approved by insurance for coverage, patients must have a certain level of IgE antibody (by blood test) and demonstrate allergy to a perennial allergen (such as dust mite or mold). Several of my patients have markedly improved on Xolair and have less frequent need for oral steroid.
Alvesco (a brand of Ciclesonide) became available at the beginning of 2008 and is a new addition to inhaled corticosteroids (ICS). Other members of ICS include: Flovent, Pulmicort, Qvar, Asmanex, Azmacort and Aerobid. Alvesco (like Qvar) is a highly fine particulate inhaler, which decreases mouth and throat deposition of the inhalant but enhances mobility of the medication to the small airways of the lung (where it is most beneficial). Alvesco is unique in that the inhaled steroid is inactive until it reaches the lung where local enzymes (called esterases) activate the drug. This means adverse effects such as hoarseness (dysphonia) and oral thrush (a form of yeast infection), which occurs in a small number of patients on ICS, are dramatically reduced. When I first heard about this inhaler I thought of several patients I had recently seen who would benefit from it.
Asmanex Twisthaler 220 (a brand of Mometasone) became available for treatment of asthma in people 12 years and older almost 4 years ago (March 2005). Earlier this year Asmanex Twisthaler 110 was approved for children age 4-11 years old. Move over Flovent Diskus, this dry powder Twisthaler (Asmanex) is also easy to use and requires only once daily dosing. Asmanex is an inhaled corticosteroid which is in the class of inhalants considered most important for achieving long-term control of persistent asthma.
Zyflo CR (a brand of Zileuton) is an old asthma medication that has a new formulation and indication. Its parent drug Zileuton, was approved in the mid 1990's and was the first asthma medication of the class of leukotriene modifiers. Other members include Accolate and Singulair. These orally active non-steroidal anti-inflammatory drugs are highly attractive to asthma care providers because they may be easily taken (swallow pill, or in some cases chewable or granules) and tend to have minimal side effects. Zyflo CR became available last year as a twice daily controller medication. Its ability to block the production of leukotrienes (substances released from certain inflammatory cells that promote inflammation in the lung) appears to be superior to the other members of its class. It is indicated for the treatment of moderate to severe bronchial asthma for ages 12 and older. Zyflo CR requires monitoring of liver enzymes (periodic blood testing required) before and after it is started. A small percentage of people may have inflammation of the liver requiring the medication to be stopped. For this reason, in order to avoid drug interactions patients must report any current or new medications being taken to their doctor.
Pharmacogenetics is the fastest growing area of research worldwide. The human genome has been fully mapped. Some medications work in one group of patients but not others. Perhaps the key to understanding which asthma drug may be right for you lies in your genetic make-up.