New approach for treating asthma

Authors of a UK study in this week’s issue of THE LANCET suggest that targeting the underlying cause of asthma—rather than treating symptoms of the disorder—could be more effective in reducing severe asthma attacks.

Conventional treatment for people with asthma relies on assessments of symptoms and simple measures of lung function. however, increased concentrations of microscopic cells called eosinophils cause the inflammation of airways in the lung that lead to asthma symptoms; eosinophils are also present in sputum several weeks before an asthma attack. Ian Pavord from Glenfield Hospital, Leicester, UK, and colleagues assessed whether the reduction of eosinophilic inflammation reduced asthma exacerbations compared with a conventional (British Thoracic Society[BTS]) approach.

74 patients with moderate to severe asthma were randomly allocated to management by either BTS asthma guidelines or by normalisation of the induced sputum eosinophil count; patients allocated to the sputum eosinophil group had asthma medication (inhaled or oral corticosteroids) regulated in response to changes in eosinophil concentration as the study progressed.

The sputum eosinophil count was 63% lower over 12 months among patients allocated to sputum management than those given conventional treatment. There were fewer severe asthma attacks (35) among patients in the sputum group than those given conventional treatment (105), and a reduction in hospitalisation for severe asthma (1 and 6 cases, respectively). Use of oral or inhaled corticosteroids did not differ between the two groups.

Ian Pavord comments: “Severe exacerbations of asthma needing courses of oral corticosteroids or hospital admission are the most serious manifestation of this disease. They lead to asthma deaths, illness, and a high cost to the health service in terms of doctor consultations, drug use, and hospital beds. Our results show that a strategy directed at maintenance of a normal airway eosinophilic count caused a large reduction in the number of severe exacerbations in a group of patients with moderate to severe asthma compared with traditional management based on the BTS guidelines. We believe such an effect has implications for management of asthma in that it strongly supports the view that airway inflammation should be monitored regularly for the best treatment of this group of patients.”