venerdì 18 maggio 2007

Asma di grado lieve: nuove evidenze terapeutiche



Due lavori pubblicati nel numero di questa settimana del NEJM mostrano interessanti risultati sul problema della terapia dell'asma bronchiale di grado lieve nell'ottica di ridurre all'essenziale l'assunzione di farmaci quali gli steroidi o i beta 2 agonisti. I risultati evidenziano la possibilità in questi pazienti di poter ridurre l'assunzione di farmaci o ad una singola somministrazione quotidiana di una associazione steroidi/salbuterolo o alla sola assunzione di beta2 agonista al bisogno.
Qui il link ad uno dei lavori.


Step-Down Therapy for Mild Asthma Shows Promise

Some patients with mild asthma could "step down" their therapy regimens to once daily or as needed, two studies in the New England Journal of Medicine find.

In one study, researchers randomized 500 patients with well-controlled asthma on twice-daily fluticasone to continue twice-daily fluticasone, once-daily montelukast, or once-daily fluticasone plus salmeterol. Treatment failure rates were elevated among montelukast users compared with fluticasone users (hazard ratio, 1.6), but didn't differ significantly among the three fluticasone groups.

The other study included 455 patients with mild asthma randomized to albuterol as needed, combination beclomethasone/albuterol as needed, twice-daily combination therapy with additional albuterol as needed, or twice-daily beclomethasone with albuterol only as needed.

Peak expiratory flow rates and exacerbation tallies were better in the as-needed combination therapy group than in the albuterol-only group; the values were similar among the three beclomethasone groups. However, patients on as-needed combination therapy had a lower cumulative dosage of corticosteroids than those in the other beclomethasone groups.

Journal Watch General Medicine Editor-in-Chief Allan S. Brett observes: "These important trials demonstrate the feasibility of step-down therapy" in well-controlled asthma, and such research could "minimize cumulative lifetime exposure to inhaled steroids, which may have systemic effects after years of use."