New asthma guidelines balance risk, control
WASHINGTON (Reuters) - New guidelines unveiled by U.S. federal health experts on Wednesday for tackling asthma carve out a new age group, children 5 to 11, for unique treatment.
Inhaled corticosteroid drugs remain the best long-term treatment to control asthma in all age groups, according to the National Heart, Lung and Blood Institute guidelines.
"Inhaled corticosteroids are the foundation of care in infants, children, pregnant women, adults and in the older population," said Dr. Stuart Stoloff of the University of Nevada, a member of the committee that crafted the guidelines.
Other drugs should be added only as needed and should be discontinued as soon as possible, experts say.
The guidelines also aim to better gauge which patients may be at future risk of asthma attacks "and represent a continuing effort to finally cure this disease," said Dr. William Busse of the University of Wisconsin, who headed the panel.
The new guidelines -- the first thorough update in 10 years of U.S. recommendations to doctors on treating and diagnosing asthma -- gave special attention to the growing problem of childhood asthma. They also offered new advice on drugs and controlling environmental factors that may trigger symptoms.
Existing guidelines had called for children 5 to 11 to be treated the same as adults. The new ones specify three age groups to get different treatment for asthma: birth to 4 years, 5 to 11, and 12 and older.
The middle group was created amid emerging signs they may respond differently to asthma medications than adults.
"There clearly are developmental distinctions we need to be thinking about," said pediatrician Dr. Robert Lemanske of the University of Wisconsin-Madison.
EVIDENCE FROM STUDIES
The panel cited strong evidence that inhaled corticosteroids are generally safe and are the most effective drug at reducing inflammation in asthma.
Inhaled corticosteroids include GlaxoSmithKline's Flovent, AstraZeneca's Pulmicort, Abbott's Azmacort, Teva Pharmaceuticals' Qvar and Schering-Plough's Asmanex.
Asthma is an inflammation of the airways. Symptoms include wheezing, shortness or breath, coughing and chest tightness. More than 300 million people worldwide suffer from asthma -- 22 million in the United States alone. Asthma kills about 3,780 Americans annually.
The panel said combination therapies, such as AstraZeneca's Symbicort and GlaxoSmithKline's Advair, which combine an inhaled corticosteroid with a long-acting beta 2-adrenergic agonist that relaxes bronchial muscle, may not be needed for children under 12.
"It looks like their response to just inhaled corticosteroids alone is so good that they may not need combination therapy," Lemanske said. He said the combination therapy seems to help many adult patients.
The experts are awaiting results of a study that may clarify the role in children of combination drugs as well as leukotriene receptor antagonists that block a chemical reaction that can inflame airways such as Merck and Co's Singulair.
The recommendations also point to newer drugs to help control severe allergic asthma. Xolair, made by Genentech and Novartis, blocks the immune system compound immunoglobulin E, which is overproduced during an allergic asthma attack.
Known generically as omalizumab, Xolair is injected and approved only for people over age 12 with severe asthma.
(Additional reporting by Julie Steenhuysen in Chicago)
