corticosteroids used for daily asthma control: Patients in the trial were taking controller medications, and used the rescue inhaler “as needed” when symptoms flared.
The two-drug approach makes sense, as it adds the missing piece of targeting inflammation, agrees Dr. Michael Wechsler, who directs the Cohen Family Asthma Institute at National Jewish Health in Denver.
Wechsler, who was not involved in the trial, says if the inhaler is approved, he sees it largely replacing standard rescue inhalers.
“I believe it should become the treatment of choice,” he says, “especially for patients with a history of asthma exacerbations.”
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The findings were published May 15 in the New England Journal of Medicine, and presented at the American Thoracic Society’s annual meeting, in San Francisco. The U.K. drug company Avillion, which is developing the two-drug approach with AstraZeneca, provided the funding.
The trial involved 3,132 patients, mostly adults and teenagers, who had moderate-to-severe asthma. They were randomly assigned to use either the two-drug rescue inhaler or albuterol only, as needed, for at least six months.
Overall, patients using the medication duo were less likely to suffer a severe asthma attack — defined as ending up in the emergency room or hospital, or needing to take oral or injection corticosteroids for at least three days.
On average, the annual rate of severe attacks was one-quarter lower among patients on the two-drug inhaler, versus those using albuterol alone.
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In managing asthma, the goal should always be minimizing the need for a rescue inhaler, says Dr. Mark Jacobson, medical director of Allergy & Asthma Physicians in Hinsdale, Ill. That means making sure patients are on an optimal dose of controller medication, and educating them on avoiding triggers.
“All that being said, when individuals do have an exacerbation, it will most certainly include a significant amount of inflammation,” says Jacobson, who was not involved in the trial.
“Therefore, when they do have symptoms it would certainly be helpful to get some inhaled steroids into them,” he adds.
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What’s next?
Like Wechsler, Panettieri believes the two-drug inhaler could replace standard treatment.
“I think this could be a game-changer,” he notes.
There is, however, the real-world issue of cost, Panettieri points out. It’s not clear how expensive the two-drug inhaler would be. But if it costs substantially more than standard rescue inhalers, insurers might balk — though, Panettieri says, there would be savings from avoiding some ER trips and hospitalizations.
The inhaler also needs to be tested more extensively in children, Panettieri says. There were too few kids younger than 12 in this trial to draw conclusions.
Wechsler says the two-drug inhaler is likely to be effective for children, and the main question will be whether it has any adverse effects. No safety issues turned up among adults and teens in this trial.
