The Pharmaceutical Journal
Vol 269 No 7227 p798
7 December 2002

This article
Reprint
Photocopy

News summary

Related websites
The Lancet (www.thelancet.com)
European Respiratory Journal (more)

New treatment approach to severe asthma could reduce exacerbations

Reducing airway inflammation caused by eosinophils can reduce asthma exacerbations without the need for further anti-inflammatory treatment, the authors of a British study have concluded.

Dr Ian Pavord and colleagues from Glenfield Hospital, Leicester, randomly allocated 74 patients with moderate to severe asthma to a conventional management strategy, based on British Thoracic Society guidelines, or an alternative approach based on normalising sputum eosinophil count. Patients in the latter group were treated with inhaled or oral corticosteroids depending on their sputum eosinophil concentration.

The researchers say that over a 12-month period fewer severe asthma attacks occurred among patients in the eosinophil count group than among those managed conventionally (35 versus 109, P=0.01). Those in the eosinophil count group required fewer rescue courses of oral corticosteroids (24 versus 73, P=0.008), and were less likely to be admitted to hospital as a result of exacerbations — only one patient from this group was admitted, compared with six from the BTS group (P=0.047).

The researchers estimate the mean cost per year per patient to be about £1,966 for those treated according to BTS guidelines but about £1,766 for the eosinophil group.

They say their approach has implications for asthma management in that it strongly supports the view that inflammation of the airways should be monitored regularly for best treatment. However, they conclude: "Although our management strategy is feasible, cost effective and efficacious in secondary care, we would be cautious in extrapolation of our findings to patients with milder disease managed in primary care. We would also have reservations about the feasibility of inducing sputum in a primary care setting." The study was published in The Lancet (2002; 360:1715).