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Dual therapy works best for controlling asthma

A combination of airway-opening drugs and inhaled inflammation-reducing steroids works better at preventing severe asthma attacks than a normal dose of steroids alone, according to a new review of recent studies.

However, higher doses of steroids seem to be just as effective as the combination therapy in preventing these attacks, a second review concludes.

The studies focus on the effects of long acting beta-2 agonist (LABA) drugs. Unlike "rescue" inhalers, which can immediately open airways during an asthma attack, LABA medications keep bronchial airways relaxed and open over a 12-hour period. The drugs include salmeterol, which is sold under the brand name Serevent and is also an ingredient in the Advair inhaler, and formoterol, sold under the brand name Foradil.

Asthma patients who used both LABA medication and an inhaled steroid were significantly less likely to have a severe asthma flare-up requiring treatment with an injected or swallowed steroid than patients taking the steroid alone, according to Muireann Ni Chroinin, M.D., of the Norfolk and Norwich University Hospital in England, and colleagues.

The reviews appear in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The rate of severe attacks dropped from 27 percent to 22 percent in patients taking the combination therapy. Ni Chroinin and colleagues calculate that 18 patients would need to be treated with LABA for one year to prevent at least one patient from having such an attack.

Combination therapy also improved overall lung function, increased the number of days where patients said they felt free of asthma symptoms and decreased the patients' use of rescue inhalers, compared to inhaled steroids alo
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Contact: Muireann N Ni Chroinin
muireann.nichroinin@nnuh.nhs.uk
Center for the Advancement of Health
18-Oct-2005


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