Editorials

β₂ Déjà Vu

This chapter presents the results of studies on analyzing drugs that act on the respiratory tract. The systemic availability of ciclesonide and fluticasone propionate has been compared by studying their effects on hypothalamic–pituitary–adrenal axis function. Ciclesonide is deposited in the lungs to a greater extent than fluticasone propionate, and with less oropharyngeal deposition. However, the results of studies with low or medium doses of fluticasone propionate are controversial; high doses clearly result in adrenal suppression. Ciclesonide had no significant effect on adrenal suppression up to daily doses of 1280 μg. In a double-blind, randomized, placebo-controlled study in 332 asthmatic children aged 24–47 months, fluticasone propionate 44 or 88 μg bd for 12 weeks had no effect on growth velocity or 12-hour overnight urinary cortisol excretion. There were similar results in 359 asthmatic children aged 1–4 years randomized to fluticasone propionate 88 μg bd or placebo for 12 weeks. In another study, 24 asthmatic children were randomized to beclomethasone dipropionate 100 μg bd or budesonide 100 or 200 μg bd in a double-blind crossover study. The results showed that the lower leg growth rate over 3 months did not differ between the groups.

L’asthme est une maladie bronchique chronique, variable et réversible. C’est une maladie prévalente et coûteuse, qui fait l’objet d’une attention particulière de la part des pouvoirs publics (un Plan asthme a été publié ; elle est inscrite dans la loi de santé publique).

Pour juger de la pertinence des soins dispensés, les paramètres à prendre en compte sont multiples : la mortalité, la gestion des urgences, des hospitalisations, le coût et des indices tels que le DALY. L’évaluation de l’asthme professionnel mérite une place toute particulière. Tous les adjectifs (variable, réversible, chronique) qui définissent l’asthme permettent de comprendre la difficulté d’une bonne prise en charge et donc d’une bonne qualité des soins.

Les pouvoirs publics doivent faire en sorte que les outils de prise en charge soient disponibles. Les médecins et tous les personnels de santé doivent s’adapter aux malades et à leur maladie. Les malades enfin doivent s’impliquer dans leur prise en charge. Seule leur participation active permettra d’améliorer à terme et de manière sensible la qualité des soins.

Au cours des 20 dernières années, des progrès substantiels ont été accomplis mais la recherche fondamentale et clinique doit être poursuivie pour les rendre encore plus perceptibles.

Asthma is a chronic airways disease characterised by variable and reversible airflow obstruction. It is highly prevalent and incurs high costs, inducing a particular consideration from health authorities (an Asthma Plan has already been published and is part of the new public heath law).

In order to assess the appropriateness of care delivered, it is important to take into account several parameters: mortality, acute asthma management, hospitalisations, costs, and other parameters such as DALY. It is also important to consider occupational asthma. All the terms (variable, reversible, chronic) that allow identification of asthma explain the difficulties in producing an efficient management strategy and good quality care.

Public heath policy has to address the availability of these different management strategies. Medical doctors and all other health professionals need to adapt themselves to the needs of patients and their disease. Finally, patients have to be involved in the management of their own disease. Their active involvement will make it possible to significantly improve the quality of care.

During the past 20 years, significant improvements have been achieved in basic and clinical science but more data are needed to improve the practical management of asthmatic patients.

In early December 2008, the Food and Drug Administration (FDA) held an unusual joint meeting of the Pulmonary–Allergy Drugs Advisory Committee, the Drug Safety and Risk Management Advisory Committee, and the Pediatric Advisory Committee to consider the safety of long-acting beta-agonists (LABAs). The meeting is described in detail in a Perspective in this issue of the Journal by Kramer,¹ who points out that decision making by the advisers and the FDA was hampered by the lack of data about the safety of LABAs.

LABAs, which are administered by inhalation, act by effecting prolonged stimulation of the β₂-adrenergic receptor. …