Combination Therapy With Inhaled Long-Acting Beta2-Agonists
Combination Therapy With Inhaled Long-Acting Beta2-Agonists
Long-acting inhaled ß2-agonists and inhaled corticosteroids are classes of drugs with different mechanisms of action that are commonly used to provide effective long-term control of persistent asthma. Scientific and clinical data support the complementary mechanisms of action of the inhaled corticosteroids and the long-acting ß2-agonists in achieving a superior level of asthma control. In addition, evidence supports significant reductions in exacerbations and effective control of airway inflammation with an inhaled corticosteroid and a long-acting ß2-agonist versus higher dosages of inhaled corticosteroids or combinations of other therapeutic agents with an inhaled corticosteroid. Finally, there are distinct economic advantages to combining an inhaled corticosteroid and a long-acting ß2-agonist in the treatment of asthma relative to other treatment regimens.
Asthma, a chronic airway disease, affects approximately 17.3 million people in the United States. It is associated with significant morbidity and mortality. Approximately 5000 deaths are attributed to asthma each year. Asthma accounts for an estimated total health care cost of $11 billion each year and an annual loss of more than 3 million work days and 10 million school days.
Adult-onset asthma frequently is encountered in primary care and has been reported to occur in over 10%, and potentially as high as 17%, of the primary care patient population. However, asthma generally is underdiagnosed in the primary care setting. Underdiagnosis of asthma by general practitioners may be a result of physicians' lack of awareness of the morbidity experienced by these patients. Given the morbidity and mortality associated with asthma and its prevalence in the primary care community, clinicians must prescribe therapy that is effective and directed to the major pathophysiologic alterations associated with this disease.
Asthma is a disease of two components: inflammation and bronchoconstriction (Figure 1). It is a complex disease involving many airway cells and mediators. To our knowledge, no single treatment regimen exists to effectively treat both the underlying inflammation and the bronchoconstriction. Thus, pharmacotherapy for asthma has focused on treating both components of the disease individually. Consequently, the drugs administered most frequently to treat asthma are those that promote bronchodilatation and those that reduce inflammation.
(Enlarge Image)
The dual components of asthma.
As the complexity of a drug regimen increases, poor adherence to a treatment plan is likely to occur. The impact of poor adherence to treatment is poor control of the underlying inflammation and bronchoconstriction, which, on a long-term basis, could contribute to the development of severe asthma exacerbations and possibly to irreversible damage to the lungs -- a process known as airway remodeling. Even widespread educational programs and promotion of national treatment guidelines have not overcome problems associated with suboptimal adherence to treatment regimens, which often include more than one controller agent. Clearly, new approaches to the long-term treatment of asthma are needed.
Long-acting inhaled ß2-agonists and inhaled corticosteroids are classes of drugs with different mechanisms of action that are commonly used to provide effective long-term control of persistent asthma. Scientific and clinical data support the complementary mechanisms of action of the inhaled corticosteroids and the long-acting ß2-agonists in achieving a superior level of asthma control. In addition, evidence supports significant reductions in exacerbations and effective control of airway inflammation with an inhaled corticosteroid and a long-acting ß2-agonist versus higher dosages of inhaled corticosteroids or combinations of other therapeutic agents with an inhaled corticosteroid. Finally, there are distinct economic advantages to combining an inhaled corticosteroid and a long-acting ß2-agonist in the treatment of asthma relative to other treatment regimens.
Asthma, a chronic airway disease, affects approximately 17.3 million people in the United States. It is associated with significant morbidity and mortality. Approximately 5000 deaths are attributed to asthma each year. Asthma accounts for an estimated total health care cost of $11 billion each year and an annual loss of more than 3 million work days and 10 million school days.
Adult-onset asthma frequently is encountered in primary care and has been reported to occur in over 10%, and potentially as high as 17%, of the primary care patient population. However, asthma generally is underdiagnosed in the primary care setting. Underdiagnosis of asthma by general practitioners may be a result of physicians' lack of awareness of the morbidity experienced by these patients. Given the morbidity and mortality associated with asthma and its prevalence in the primary care community, clinicians must prescribe therapy that is effective and directed to the major pathophysiologic alterations associated with this disease.
Asthma is a disease of two components: inflammation and bronchoconstriction (Figure 1). It is a complex disease involving many airway cells and mediators. To our knowledge, no single treatment regimen exists to effectively treat both the underlying inflammation and the bronchoconstriction. Thus, pharmacotherapy for asthma has focused on treating both components of the disease individually. Consequently, the drugs administered most frequently to treat asthma are those that promote bronchodilatation and those that reduce inflammation.
(Enlarge Image)
The dual components of asthma.
As the complexity of a drug regimen increases, poor adherence to a treatment plan is likely to occur. The impact of poor adherence to treatment is poor control of the underlying inflammation and bronchoconstriction, which, on a long-term basis, could contribute to the development of severe asthma exacerbations and possibly to irreversible damage to the lungs -- a process known as airway remodeling. Even widespread educational programs and promotion of national treatment guidelines have not overcome problems associated with suboptimal adherence to treatment regimens, which often include more than one controller agent. Clearly, new approaches to the long-term treatment of asthma are needed.
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