Older women with severe asthma may be at greatest risk for undertreatment, say researchers who assessed adherence to the National Asthma Education and Prevention Program medication guidelines among participants in the Nurses’ Health Study. Of the 5,107 women who reported physician-diagnosed asthma, only 57% with mild asthma, 55% with moderate asthma, and 32% with severe asthma were taking medications as advised by the guidelines.

The figures seemed somewhat baffling, especially considering that the women in the study were health care providers them­selves. Psychosocial factors (e.g., marital status, social isolation), lack of insurance, and other possible influences could not completely account for the lack of adherence or the age gradient. Although the investigators had anticipated that low adherence among women with severe asthma would be a result of reluctance to use systemic corticosteroids, they found, in fact, that both those drugs and long-acting bronchodilators were underused.
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The greatest increase in asthma-related mortality today is among older women. The researchers urge health care providers to make greater efforts to evaluate asthma severity and to step up therapy when indicated.

The National Asthma Education and Prevention Program is issuing new treatment guidelines for managing asthma during pregnancy. Poorly controlled asthma can lead to serious problems for pregnant women and their fetuses.

Medication can be increased, if needed, or decreased, when possible; it might be safer to take medications than to experience asthma exacerbations. If the mother has trouble breathing, the fetus will also have trouble getting oxygen.
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Maternal asthma is associated with an increased risk of infant death, pre-eclampsia, premature birth, and low birth weight.

Pregnant patients with persistent asthma should be checked at least monthly. Albuterol (e.g., Proventil®, Schering) should be available to provide quick relief of symptoms.

Women should limit their exposure to irritants (e.g., dust mites, tobacco smoke).

Adults with mild persistent asthma may be able to control attacks by taking corticosteroids only when needed, instead of taking anti-inflammatory drugs daily, according to the Improving Asthma Control Trial (IMPACT).

Conducted by the National Heart, Lung, and Blood Institute’s Asthma Clinical Research Network, the one-year, multicenter study found that participants who took corticosteroids when symptoms were present had rates of severe exacerbations and declines in asthma-related lung function that were similar to those of patients using daily long-term control medication. Viagra Online Canadian Pharmacy

The new findings might not apply if asthma has developed recently or if patients have more frequent symptoms or more severe asthma. The updated guidelines are to be released in 2006.

Dey LP has announced the FDA’s approval of its New Drug Application (NDA) of its marketing partner, Critical Therapeutics, Inc., for twice-daily extended-release zileuton tablets (Zyflo CR).

Zyflo CR and Zyflo are approved for the prophylaxis and chronic treatment of asthma in adults and children 12 years of age and older. Zyflo was first approved in 1996 for the treatment of asthma.
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The recommended dose of Zyflo CR is two extended-release 600-mg tablets twice daily within one hour after morning and evening meals (for a total daily dose of 2,400 mg).

The recommended Zyflo dose is one 600-mg immediate-release tablet four times a day (for a total daily dose of 2,400 mg).

Omalizumab (Xolair, Genentech) injection is approved to treat moderate-to-severe persistent asthma in adults and adolescents 12 years of age and older who have a positive skin test or reactivity in vitro to a perennial aeroallergen and who have not responded adequately to inhaled corticosteroids.

The FDA mandated the revised label because some patients receiving Xolair can experience anaphylaxis. This life-threatening reaction can occur at any dose and up to 24 hours later—even if the patient had no reaction to the first dose.
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A boxed warning, as well as updated warnings, precautions, and adverse reactions, have been added. A medication guide about the risk of anaphylaxis must be distributed to patients with each dose of omalizumab.

For the first time in a decade, the National Asthma Education and Prevention Program has updated clinical guidelines for the diagnosis and management of asthma. New features include:
• an expanded section on asthma for children 5 to 11 years of age.
• information on medications.
• recommendations for patient education other than in a physician’s office.
• advice for controlling environmental factors that can cause symptoms of asthma.

The guidelines reaffirm that patients with persistent asthma need both long-term control and quick-relief medications. Also included are new recommendations:
• inhaled corticosteroids: considered the most effective long-term control medication for all age groups.
• leukotriene receptor antagonists and cromolyn: for long-term control.
• long-acting beta agonists: as adjunct therapy with inhaled corticosteroids.
• omalizumab (Xolair, Genentech): for severe asthma.
• albuterol, levalbuterol, and corticosteroids: for acute exacerbations.

(Source: National Heart, Lung, and Blood Institute, August 29, 2007.)