Chest
ReviewsThe 1997 Asthma Management Guidelines and Therapeutic Issues Relating to the Treatment of Asthma
Section snippets
Nedocromil
One of the new asthma medications, nedocromil, has an anti-inflammatory action similar to that of cromolyn.1, 2 The drug's mechanism of action appears to be inhibiting inflammation on the molecular level by blocking chloride channels and modulating mast cell mediator release and eosinophil recruitment.1, 3, 4 Nedocromil is effective in reducing bronchospasm brought on by cold, dry air,5 bradykinin aerosol,2 and exercise.6 It is also proven to reduce the need for quick-reliefβ 2-antagonists,
Clinical Efficacy Comparisons of Inhaled Corticosteroids: Factors Influencing Efficacy
The physiochemical properties of the glucocorticoid molecules determines the pharmacokinetics of inhaled corticosteroids. Due to the various properties of the different molecules, the Expert Panel points out that data suggest “… that different inhaled corticosteroid preparations are not equivalent on a per puff or microgram basis.”1
Although not well defined, some of the factors thought to influence efficacy are topical potency; lipophilicity; the rate of dissolution; receptor-binding affinity;
Comparative Risks Among Inhaled Corticosteroids: Hypothalamic-Pituitary-Adrenal Axis Suppression
For more than two decades, clinical investigators have questioned whether the use of inhaled corticosteroid therapy suppresses the hypothalamic-pituitary-adrenal (HPA) axis. The Expert Panel states that this issue is “complex and requires further study,”1 but two studies cited by the Expert Panel illustrate that not all inhaled corticosteroids carry the same amount of risk.
The first study found no HPA axis suppression in asthmatic children receiving BDP (mean dose, 490 μg/d) compared with
Expectations With Different Delivery Systems Used With Inhaled Corticosteroids
Other factors that can influence the efficacy of inhaled corticosteroids are the devices used to deliver the drug directly to the lungs via inhalation. When used properly, spacers or holding chambers decrease the amount of oropharyngeal deposition of the drug and increase the amount of deposition in the lung.37 The Expert Panel does not recommend one delivery device over another, but instead communicates the optimal technique and therapeutic issues with each device.
A majority of inhaled
Summary
In the 6 years since the 1991 Expert Panel Report was released, an increasing number of therapeutic choices have been introduced to treat and control asthma. The pharmacologic component of the 1997 Expert Panel Report provides clinicians with a detailed, annotated guide on how and when to use these medications.
It is hoped that clinical research will become available so that the next Expert Panel Report can include definitive data on the safety and efficacy of newer asthma medications (eg,
References (57)
General pharmacology, pharmacokinetics, and toxicology of nedocromil sodium
J Allergy Clin Immunol
(1993)- et al.
Cromolyn versus nedocromil: duration of action in exercise-induced asthma in children
J Allergy Clin Immunol
(1995) - et al.
Nedocromil sodium is more effective than cromolyn sodium for the treatment of chronic reversible obstructive airway disease
Chest
(1993) - et al.
Respiratory arrests in young asthmatics on salmeterol
Respir Med
(1993) Asthma therapy: what's new and is it necessarily better [editorial]?
Chest
(1997)- et al.
Churg-Strauss syndrome associated with zafirlukast
Chest
(1998) - et al.
Effect of cysteinyl-leukotriene receptor antagonist ICI 204.219 on allergen-induced bronchoconstriction and airway hyperreactivity in atopic subjects
Lancet
(1991) - et al.
Leukotriene D4receptor blockade inhibits the immediate and late bronchoconstrictor responses to inhaled antigen in patients with asthma
J Allergy Clin Immunol
(1992) - et al.
Comparison of budesonide and beclomethasone dipropionate in patients with severe chronic asthma: assessment of relative prednisolone-sparing effects
Br J Dis Chest
(1985) - et al.
A comparative study of the effects of an inhaled corticosteroid, budesonide, and a β2-agonist, terbutaline, on airway inflammation in newly diagnosed asthma: a randomized, double-blind, parallel-group controlled trial
J Allergy Clin Immunol
(1992)