DENVER -- Asthma sufferers worried by research that beta-agonist
drugs used to control their condition might pose a risk of death
could have an alternative, according to a study published Sunday in
the New England Journal of Medicine.
The drug tiotropium has been used to treat chronic obstructive
pulmonary disease, and now research at Denver's National Jewish
Health and other hospitals across the country have found it might
also work for asthma.
The study observed 210 people over 48 weeks, placing patients on
tiotropium for 14 weeks.
"Obviously, we feel very satisfied," said Richard Martin,
chairman of the Department of Medicine at National Jewish and the
principal investigator for the Denver site of the study.
"It really gives physicians another option in treatment of
asthma," Martin said. "The results are undeniable."
Martin said he is confident enough to start using tiotropium to
treat some of his asthma patients.
Beta agonists, such as Serevent and Foradil, are commonly used
in combination with inhaled corticosteroids. Medicines such as
Advair and Symbicort contain the combination.
Corticosteroids are used to control swelling and inflammation,
while beta agonists act as bronchodilators that open up airways to
control and prevent spasms.
Tiotropium is also a bronchodilator, but instead of opening up
airways by relaxing the surrounding muscles, it does so through the
nervous system in the lungs.
In February, the Food and Drug Administration issued a warning
on beta agonists, recommending that patients limit their use and to
always use them without combining them with corticosteroids.
The new requirements were based on analyses of clinical trials
showing that use of the drugs was associated with an increased risk
of a severe worsening of asthma symptoms, leading to
hospitalization in adults and death in some asthma patients, the
FDA said.
Other researchers and pharmaceutical companies have disputed the
FDA's warnings.
Martin said he is not convinced that beta agonists are dangerous
but said the real problem lies in not knowing how and why they have
caused problems for some patients.
Isaac Melamed, a local asthma-research doctor and founder of 1st
Health Centers and ImmunoE, said he is hopeful that tiotropium will
prove useful but wants to further review the data in the study.
"If this can replace long-acting beta agonists, that can be a
great thing," Melamed said.
"Definitely a very interesting concept," he said.
Martin said that in the clinical study, no adverse effects were
reported but that he would encourage more studies on tiotropium in
asthma patients.
In addition to possibly being safer, tiotropium's effects last
about 24 hours, meaning patients might need to medicate only once a
day instead of twice a day.
"If we can cut things down, it makes it easier for the patient
and, hopefully, we increase compliance," Martin said.