Combination therapy is changing asthma treatment

February 2002

ORLANDO, Fla. — Asthma is the leading chronic illness among children, and its prevalence has soared in recent years, with incidence increasing about 57% over 1980 statistics — and hospitalization rates for asthma jumping 78% since 1980.

With the incidence of asthma illness on the rise, many pediatricians have had to turn to combination therapy for children with chronic persistent symptoms.

While combination therapy formulations have only been approved in children ages 12 and older, Stanley J. Szefler, MD, of the National Jewish Medical and Research Center and the University of Colorado Health Sciences Center, said pediatricians are in an “exciting time” of advances and new therapeutic possibilities for treating pediatric asthma.

Trials for combination therapy for younger children are ongoing, he told a group of allergists at the American College of Allergy, Asthma and Immunology meeting held here.

Treatment to prevention

“We’re trying to move from the use of bronchodilators to relieve bronchospasm, to using anti-inflammatory therapy to prevent bronchospasm,” Szefler said. The ultimate goals are to prevent the symptoms resulting from asthma inflammation and resolve and prevent progression of asthma.

Szefler began his discussion by outlining the phases of asthma in children, with step 1 being the mild cases, step 2 the mild-persistent asthmatic and the last step the severe-persistent asthmatic.

The prevalence of asthma has been increasing since the early 1980s for all age, sex and racial groups. • higher among children than adults • higher among girls than boys • higher among blacks than whites Source: NIH, NHLBI

In terms of advantages and disadvantages of combination therapy, Szefler said the advantages are that therapy reduces symptoms, improves pulmonary function, reduces bronchospasm and prevents allergen-induced inflammation.

Szefler said the National Heart, Lung and Blood Institute guidelines for the treatment of moderate and severe persistent asthma offer the alternative of moderately high doses of inhaled corticosteroids or a lower dose of an inhaled glucocorticoid combined with a long-acting bronchodilator.

He outlined the three classes of drugs that qualify for combination with inhaled corticosteroids: long-acting ß-agonists, leukotriene-receptor antagonists and sustained-released theophylline (Some of these have been removed from the market. See related story.).

He said while the long-acting ß-agonists are the most effective, all three have resulted in better asthma control as compared with increasing inhaled steroid dose.

He said as trials continue in children, there are new therapies emerging that could “revolutionize” asthma therapy.

“Young children are at the frontier of our understanding of new medication,” Szefler said. But he cautioned pediatricians have to look at reliable outcome measures to ensure that early interventions aren’t carrying the potential for increased risk of adverse events.

For more information:

• Szefler S. Advances in combination therapy: application to pediatric asthma. Tuesday Breakfast Symposium. Presented at the American College of Allergy, Asthma and Immunology. Nov. 16-20, 2001. Orlando, Fla.
• Szefler SJ. Asthma: the new advances. Adv Pediatr. 2000;47:273-308.
• Szefler SJ. Meeting the needs of the modernization act: Challenges in developing pediatric therapies. J Allergy Clin Immunol. 2000;106:115-17.