New Medications for Asthma

Tuesday, July 21, 2009, 12:25
Asthma
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Andrew:

Let’s bring on a parent. Bev is joining us from Fort Worth, Texas. Bev, thank you for being on our program.

Bev:

Well, thank you.

Andrew:

And I understand your 18-year-old son has been dealing with asthma for many years. Is that right?

Bev:

Yes, for the past 13 years.

Andrew:

And what sort of medications are you using in your household to keep that asthma under control?

Bev:

The chronic medication usage that he is on is Flovent, Serevent, albuterol, Astelin, Nasacort, Claritin-D, and Tilade. He’s classified as moderate persistent.

Andrew:

Bev, what’s your question tonight for Dr. Gower?

Bev:

What are some new medications or management plans that are on the horizon for asthma?

Dr. Gower:

Well, as far as the new medications, there’s a new one coming down the pike, but it will probably be six to nine months. It will be similar to Flovent. It’s not on the market at this point. I’ve done some research on that. It’s similar to Flovent, and that’s one of the newer ones coming out. It’s an inhaled cortisone dry powder inhaler. As far as the Serevent, that is the only medicine in that realm. There’s a new one coming that should be out within six to twelve months also that may have short-acting as well as long-acting ability. The Serevent is a longer-acting beta-2 agonist. It relaxes the muscles in the airways. The albuterol is the short-acting reliever. There’s nothing that’s coming down the pike that will relieve that.

The Tilade is probably the weak sister here as far as the medicines he’s on. It’s an excellent, safe medication. It’s a controlling one. Nothing is coming down the pathway to replace the Tilade. If he’s on the Flovent at reasonable doses, he might be able to do without the Tilade.

Another replacement that has come out over the last couple, three years, would be there’s three different medicines called leukotriene modifiers, and these are excellent medicines. They’re the first new breakthrough in 20 years in the treatment of asthma, and they’re controller medicines, not for acute treatment of asthma.

There are two of them that I use. One of them is four times a day and has more drug interactions, so I tend to use montelukast, which is licensed now down to age two and older, and another one called zafirlukast, which is seven years of age and older. And the first one is once a day, and the second one is two times a day. These are controller anti-inflammatory medicines that work in a different way than any of the ones that he’s on now, and I would suggest that one consider that, perhaps instead of the Tilade, as a stronger, certainly a different kind of anti-inflammatory controlling medication.

One of the benefits of that is that it is a pill, and by being a pill, it can affect the skin as well as the eyes and nose and the lungs. It’s only licensed for the lungs, but there is work ongoing in seeing if it can also be good in urticaria or hives, eczema as well as hay fever or allergic rhinitis. So if he does have the allergic rhinitis, he might get some benefit from that pill, then he could take perhaps less of the Astelin, perhaps less of the Claritin-D.

There are some other research products, but there’s nothing on the immediate horizon other than what I mentioned. There’ll be some, in the next several years, medicines that we can inject perhaps in the vein once a month, or two, or three months that will block some of the allergic responses by blocking the allergic antibody, IgE. But these are two, three, four years down the line.

Andrew:

Dr. Gower, you mentioned many different medications. Will some of these medications be combined so that it’s easier to take or be compliant with?

Dr. Gower:

Yes. There’s a new one that should be out here in the near future. It will be called Advair, and it’s a combination of the Flovent or fluticasone that your son is on now, and it’s also consists of the Serevent. So it will not be a brand new medicine; it will be just a combination of those two, and it will be twice a day in a dry powder form. So it will make it more convenient by far.

Andrew:

You mentioned the term “dry powder,” and while Bev is probably familiar with it, some other parents may not be. I have this vision of the inhaler where there’s this mist that you breathe in, and I know there’s been a problem sometimes where not all of the mist gets in, and there are these tubes or little plastic tubes or spacers to help get more of it to the lungs. This dry powder, is that an advantage, and if so, why?

Dr. Gower:

The dry powder is probably an advantage because it does not have a propellant, first of all, which can sometimes irritate the lungs in some patients. Also, by being a dry powder, you just take the cap off and put one’s mouth on and breath a normal inspiratory movement and the dry powder will be inhaled into the lungs. The metered dose inhalers that we’ve had in the past give about 10 to 15 percent delivery to the lungs of the medication. The dry powder forms will deliver 20 to 30 percent of the medication to the lungs. So it’s more efficient; it’s easier to use, especially for youngsters who do not have to coordinate the timing of pushing a button on the inhaler and then inhaling at the right time and getting it in.

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