Asthmatics May Be Able to Take Less Medication
Asthmatics often end up on more potent drugs after a flare-up. But it's much less common for doctors to "step down" the intensity of treatment when symptoms are controlled.
A study in this week's New England Journal of Medicine found that reducing dosages is viable for people with mild, persistent asthma who are on twice-daily doses of inhaled corticosteroids such as fluticasone.
The study compared two alternatives: montelukast, which is marketed by Merck as Singulair, and a combination of fluticasone with salmeterol, which is sold by GlaxoSmithKline as Advair Diskus. Montelukast is a once-a-day pill; the fluticasone with salmeterol is delivered once daily via an inhaler. The researchers found that both treatments were about as effective as fluticasone alone, though monetelukast was slightly less so.
"The difference was statistically significant but not clinically significant," says Jay Portnoy, president elect of the American College of Allergy, Asthma and Immunology. "I'm not saying the results are wrong, but I question the spin and the interpretation." Portnoy notes that the maker of fluticasone with salmeterol, GlaxoSmithKline, sponsored the study. His bottom line: Both options are safe and effective.
People wondering if their asthma is being controlled properly can click here and follow the link to the Asthma Control Test. This short questionnaire will give you a sense of whether your asthma is under control. And when you next visit your doctor, talk about your options. "There are lots of good choices," says Stephen Peters, one of the study leaders.