New drug combo is “a paradigm shift” in preventing asthma attacks

Two asthma drugs — a rescue medication and corticosteroid — significantly reduced asthma attacks.

A new combination of asthma drugs not only works better for treating asthma attacks, but also lowers patients’ chances of future attacks, according to a big study by researchers at Rutgers and Italy’s University of Ferrara.

“This represents a paradigm shift in the treatment of asthma,” Rutgers professor of medicine Reynold Panettieri Jr. said in a statement. “We see this combination treatment, which is the first of its kind, as becoming part of standard therapy.”

Hard to breathe: Asthma is a chronic breathing disorder caused by the airways of the lung being swollen or inflamed. These passageways are then more susceptible to triggers, like cold weather, dust, or pet dander.

When you breathe in a trigger, the passageways inflame even more, and the muscles which surround them can become tighter — leading to a frightening, and potentially life-threatening, asthma attack.

The disease burden is high; the WHO estimates that 262 million people were afflicted with asthma in 2019, with 455,000 dying prematurely from it.

The drug combination lowered both the short and long term the risk of asthma attacks.

The usual: The standard “maintenance” treatment of asthma involves using inhalants with two different asthma drugs, the researchers said. One is a long-acting drug which binds to proteins on the muscles called beta receptors, causing the muscles to relax; the other is a corticosteroid, which inhibits inflammation.

During an asthma attack, patients use what are called “rescue” medications like albuterol, which rapidly bind to the beta proteins, and they may even be prescribed oral steroids. 

Oral steroids, while effective, can cause myriad side effects, including fluid retention, weight gain, high blood pressure, and psychological effects like mood swings, memory irregularities, and confusion.

For this reason, the researchers are looking for ways to reduce oral steroid dependency.

Combining asthma drugs: In their study, published in the New England Journal of Medicine, they tested whether a combination of albuterol and the corticosteroid budesonide could lower the number of asthma attacks when taken together. Budesonide decreases the severity and regularity of asthma attacks when taken daily, but it doesn’t work as a rescue medication by itself.

The team enrolled 3,312 asthma patients from the US, Europe, and South America into a randomized controlled trial to test both the safety and effectiveness of the inhaled combination of the asthma drugs.

“This represents a paradigm shift in the treatment of asthma. We see this combination treatment, which is the first of its kind, as becoming part of standard therapy.”

Reynold Panettieri Jr

Since many of the patients were already on maintenance therapies, they randomly received one of three rescue medication combinations: albuterol and a high dose of budesonide; albuterol and a low dose of budesonide; and a control group of albuterol alone. 

The high-dose combination reduced the chances of another asthma attack by 24% in the short term, and 27% in the long term. The combo actually allowed for 33% reduction in the use of corticosteroids because it delivers them so effectively.

“With this new inhaler that delivers more inhaled steroids every time patients take the rescue therapy, they’re getting more at a time when they’re having a flare-up and when they need it,” Panettieri said. 

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