Asthma ‘pill-a-day’ shows similar effectiveness as inhalers: Study

By Dr. Ananya Mandal, MDMay 5 2011

A new study has shown that a ‘once-a-day’ pill may be on par with an inhaler at combating asthma. This tablet, say researchers could revolutionize treatment for the condition, meaning patients are no longer reliant on inhalers, which many find difficult to use. Around 5.4 million Britons have asthma, including 1.1 million children.

Results of the study has shown that the pills, known as leukotriene receptor antagonists (LTRAs), were just as good at treating symptoms as inhalers, and patients were far more likely to remember to take them. These pills have been available for several years, known by their brand names Singulair and Accolate but are less commonly prescribed.

For the study the researchers looked at 650 patients aged 12 to 80, who had either used preventative inhalers or LTRA pills. Their study, published in the New England Journal of Medicine, concludes that 80 per cent of asthmatics who don’t like using preventative inhalers could take the daily pill instead. The researchers found that quality-of-life scores improved over two years in both trials, with differences in the two scores meeting equivalence at two months and approaching equivalence at two years. There were no significant differences between the two groups in exacerbation rates or asthma control questionnaire scores.

According to lead author Professor David Price, from the University of Aberdeen and the University of East Anglia, “We hope these findings will increase the options for healthcare professionals when prescribing for this common but disruptive disease.”

“Study results at two months suggest that LTRA was equivalent to an inhaled glucocorticoid as first-line controller therapy and to LABA as add-on therapy for diverse primary care patients. Equivalence was not proved at two years. The interpretation of results of pragmatic research may be limited by the crossover between treatment groups and lack of a placebo group,” the authors write.

In terms of costs, a 2010 United Kingdom study that compared the costs of the two therapies for initial asthma control found that the price of LTRAs was “significantly higher” than that of inhaled steroids. Several authors disclosed financial relationships with pharmaceutical companies; research was supported by Merck Sharp & Dohme, AstraZeneca, and Research in Real Life.

“These study findings don't make me change my mind. It confirms that there are various options, and there's not one answer for everyone,” said Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital and Medical Center in Detroit. “The National Institutes of Health has issued guidelines on managing asthma, and a lot of literature review went into setting up those guidelines that recommend trying inhaled corticosteroids first. And, it's been my experience that I get good control with more patients using inhaled corticosteroids,” she said. “But if someone is having trouble using an inhaler regularly or they're having side effects, then I would think about changing their medication,” she added. “But, there's no one medication that will help everyone, and no medication is without risk.”