Cromolyn, or sodium cromoglycate, and inhaled corticosteroids both block the action of certain inflammatory cells in the lungs. Physicians recommend both types of medication for persistent asthma, but individual studies disagree about which type of medication works best, the reviewers found.
"The safety of sodium cromoglycate has been well established, but the effectiveness of sodium cromoglycate in controlling asthma symptoms may be limited," Guevara said, adding that the lack of effective control might be one reason cromolyn has fallen out of favor compared to inhaled corticosteroids since the 1990s.
Cromolyn's manufacturer has changed several times during the past two decades, which may also explain why the drug's popularity has waned, Storms said. The succession of companies "did not spend one dollar in research in the past 20 years to study cromolyn. All of the data are old and most are forgotten," he said.
The Cochrane reviewers examined 17 studies involving 1279 children and eight studies involving 321 adults with asthma. They found no differences in serious side effects between those using the steroids and those using cromolyn, but acknowledge that adverse effects were reported inconsistently.
Guevara and colleagues conclude that inhaled corticosteroids were superior to cromolyn regardless of the severity of the asthma. They suggest the results are so decisive that future studies comparing the two types of drugs "may not be warranted."
Storms said some patients may still prefer to stay away from inhaled corticosteroids.
"We need to examine the total patient and treat the patient, not the disease. When I tell patients I am suggesting they take an ICS [inhaled corticosteroid], many of them get that wide-eyed gaze because of the word 'steroid.' Then I discuss the fact that ICS are inhaled and not systemic but many patients would still prefer to try something else, if possible.
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Contact: James Guevara
guevara@email.chop.edu
Center for the Advancement of Health
18-Apr-2006