Researchers say that anti-inflammatory drugs in pill form are reasonable alternatives to inhalers.
Researchers say that anti-inflammatory drugs in pill form are reasonable alternatives to inhalers. iStockphoto.com
Asthma can be devilishly hard to manage with medication, and that's especially true for many of the millions of children who have it.
Inhalers that deliver corticosteroids to the lungs have long been the drugs of choice for long-term control. But inhalers need to be used every day to fend off asthma attacks, and that's a hard sell for lots of kids.
Now researchers in England say that anti-inflammatory drugs, called leukotriene modifiers, that come in pills are reasonable alternatives to the plastic tube.
Leukotriene modifiers reduce inflammation caused by allergies, and are already widely prescribed for asthma. But there's mixed evidence as to whether they do as good a job as corticosteroids in reducing the risk of asthma attacks. They're also much more expensive than corticosteroids.
But a group of researchers led by David Price, a respiratory specialist at the University of Aberdeen in Scotland, gave 306 children and adults with asthma one drug or the other, and followed them for two years.
The participants reported that the two drugs were equally effective in reducing asthma symptoms after two months. At two years, however, the data didn't prove the different medicines were equal. The results were published in the current New England Journal of Medicine.
What's interesting about this study is that it didn't follow standard protocol for clinical trials: There was no placebo group that didn't take medication, and both patients and doctors knew which medication they were taking. In other words, the study wasn't blinded.
This way of testing medications has its limitations, but it may more accurately reflect the real world of patient care, according to an NEJM editorial commenting on the study. "The ease of taking a pill should be particularly attractive in developing parts of the world," the editorialists wrote, "where most patients with asthma remain untreated."
Singulair, the brand name for one of the leukotriene modifier pills, goes off patent in 2012, so cheaper versions should be available before too long. (The original patent protection was embroiled in lawsuits for years.) The patent for Accolate, a similar product, expired last year, but cheaper generic versions haven't yet been approved.
There are some caveats. Although the study was commissioned by and funded mostly by the U.K. government, the same drug companies that make leukotriene inhibitors — Merck (Singulair) and AstraZeneca (Accolate) — also kicked in some cash.
And lead researcher Price has gotten grants, research support, and speaking fees from Merck and AstraZeneca, as well as a boatload of other pharmaceutical companies. So, as exciting as the prospect of tossing the inhaler might be, hold on to it until more research is available.