BRONCHODILATORS HELP MANAGE COPD

A Cochrane systematic review confirms that using an inhaled short-acting ß2-agonist (ISABA) improves lung function and decreases breathlessness in patients with chronic obstructive pulmonary disease (COPD).

The review identified 13 randomized, controlled, crossover trials involving a total of 237 patients with COPD. The ISABAs studied included isoproterenol, terbutaline, and albuterol. The drugs were given for one to eight weeks.

At the end of treatment, patients given ISABAs had improved forced expiratory volume in one second and forced vital capacity compared with those receiving placebo. Postbronchodilator morning and evening peak expiratory flow rates were also significantly better in the active treatment group.

In the four studies that examined patient preference, patients were nearly nine times more likely to prefer ISABAs than placebo. Although the populations varied in terms of disease severity and acute bronchodilator response, findings were consistent across the studies.

Research has shown that inhaled long-acting ß2-agonists also improve symptoms and quality of life in patients with COPD. In fact, the authors noted, the long-acting drugs may provide better symptom relief over the course of the day and may prove more effective than ISABAs.

Ram FSF, Sestini P. Regular inhaled short acting ß2 agonists for the management of stable chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. Thorax. 2003;58:580-584.

MEDICATIONS AND INABILITY TO WORK ACCOUNT FOR HIGHEST ASTHMA COSTS

A cross-sectional survey of 401 adults with asthma found that while asthma medications make up the highest direct costs, indirect expenses may exceed the cost of drugs. Furthermore, per-person expenditures differ according to asthma severity.

The study conducted by Cisternas et al used interviews that included questions on asthma-related health care use, medications, and indirect costs. Changes in employment status, occupation, or work hours were assessed during follow-up interviews.

Total costs averaged $4,912 among all respondents; direct costs accounted for about two thirds of this. Medical costs made up 85% of direct costs. Ninety-eight percent of all participants reported using at least one asthma medication. Prescription asthma medications accounted for half of the total direct costs. Sixty-one percent of indirect costs were attributed to complete cessation of work due to asthma. Loss of full or partial workdays accounted for another 34% of indirect costs.

Total costs ranged from $2,646 for patients with mild asthma to $12,813 for those with severe illness. Medications accounted for 47% of total costs for those with mild asthma but only 19% of total costs in patients with severe asthma.

The authors calculated that reducing disease severity to moderate in 5% of patients with severe disease would result in an annual savings of $1.4 billion nationwide.

Cisternas MG, Blanc PD, Yen IH, et al. A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol. 2003; 111:1212-1218.

FLUTICASONE PROPIONATE LOWERS RELAPSE RATES IN ATOPIC DERMATITIS

In patients with atopic dermatitis, adding fluticasone propionate to standard emollient therapy reduces the incidence of relapses.

A randomized, double-blind, placebo-controlled, parallel-group study (funded by GlaxoSmithKline) enrolled 376 patients who had been experiencing exacerbations of atopic dermatitis. Symptoms were treated using fluticasone propionate cream (0.05%) or ointment (0.005%) once or twice daily for four weeks. When symptoms resolved, patients either continued the same fluticasone propionate preparation or were switched to placebo; in both cases, the frequency of administration was changed to two successive evenings per week for up to 16 weeks. Patients also routinely applied an emollient as needed.

Severity of atopic dermatitis was rated on a scale of 0 to 3 (0 = absent, 3 = severe). Patients were assessed every two weeks during the initial treatment phase and at two, six, 10, and 16 weeks during the maintenance phase.

Patients who used fluticasone propionate in addition to emollients reduced their risk of relapse to one sixth that of the relapse rate in placebo groups. The median time to relapse exceeded the 16-week observation period with fluticasone but was 6.1 weeks with placebo.

Because of their occlusive properties, ointments are generally viewed as more effective than creams. However, 40% of those who used the ointment preparation had relapses by 16 weeks, compared with 19% of patients who applied the cream. The authors speculated that patients often find ointments messier to use, and this may have affected compliance.

Berth-Jones J, Damstra RJ, Golsch S, et al. Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study. BMJ. 2003;326:1367-1372.