What Is New In Small Airways Research
By Ves Dimov, MD
Allergist/Immunologist, Assistant Professor, University of Chicago
University of Chicago
Posted 23 January 2013
The Asthma Disease Activity Score (ADAS) is a new tool that predicts future asthma attacks.
The authors of this Merck-sponsored study aimed to develop a weighted and responsive measure of asthma disease activity. They used two previously conducted clinical trials to develop the Asthma Disease Activity Score (ADAS-6).
The ADAS-6 assessed different manifestations of asthma:
- FEV(1) (percent predicted)
- Asthma Quality of Life Questionnaire-Symptom domain
- Rescue beta-agonist use
- Nocturnal awakenings
- Peak expiratory flow diurnal variability
- Rescue beta-agonist use diurnal variability
The ADAS-6 distinguished levels of disease activity and response to different treatment intensities (P less than 0.0001). In particular, ADAS-6 was highly responsive to treatment effects. Using ADAS-6 as the primary end point could reduce the sample size needed to detect a change in outcome in clinical trials. Increments in the ADAS-6 predicted the risk of future asthma attacks. A simplified Asthma Disease Activity Score 4-variable version (ADAS-4) demonstrated similar properties.
The authors concluded that ADAS-6 and ADAS-4 are new measures of asthma disease activity that might better separate treatment effects, predict future asthma attacks, and reduce sample size.
Editor's note: The findings of this pharmaceutical company-sponsored and authored publication are promising, but they need an independent confirmation.
Source: Greenberg S, Liu N, Kaur A, Lakshminarayanan M, Zhou Y et al. The asthma disease activity score: a discriminating, responsive measure predicts future asthma attacks. Journal of Allergy & Clinical Immunology 2012; 130(5):1071-1077.e10. doi:10.1016/j.jaci.2012.07.057
Once-daily fluticasone furoate is efficacious in patients with symptomatic asthma on low-dose inhaled corticosteroids.
Fluticasone furoate (FF) is an inhaled corticosteroid (ICS) with 24-hour activity in development as a once-daily treatment for the long-term management of asthma. This study assessed the efficacy of 4 doses of once-daily FF administered using a dry powder inhaler in patients older than 12 years with moderate asthma, uncontrolled on low-dose ICS (fluticasone propionate [FP] 200 μg/day or equivalent).
The study was double-blind, placebo-controlled, and randomized 600 patients. It was funded by the manufacturer, GlaxoSmithKline.
At week 8, there was no evidence of a dose-response relationship between FF doses. Improvement with once-daily FF was similar to or greater than that for twice-daily FP. Oral candidiasis was reported in 0 to 4% of patients; 24-hour urinary cortisol excretions were similar to placebo.
FF 100 to 400 μg once daily in the evening was effective in patients with asthma uncontrolled on low-dose ICS, with 100 μg and 200 μg, considered the most applicable doses.
Editor's note: The availability of another once-daily inhaled steroid (fluticasone furoate) will expand the treatment options for patients with asthma.
Source: Bleecker ER, Bateman, ED, Busse WB, Woodcock A, Frith L et al. Once-daily fluticasone furoate is efficacious in patients with symptomatic asthma on low-dose inhaled corticosteroids. Annals of Allergy, Asthma & Immunology, 2012; 109(5): 353-358.e4.
Prescribing inhaled steroid at the time of Emergency Department (ED) visit for asthma decreases ED visits/admissions and saves $7,000 per 100 patients.
This cost-effectiveness analysis compared three ED-based inhaled corticosteroid (ICS) delivery options:
- usual care (recommending outpatient follow-up)
- prescribe (uniformly prescribing ICS)
- dispense (uniformly dispensing ICS)
Rates of ED relapse visits and hospitalizations within one month of ED visit were compared across all three arms.
Rate of return to ED per 100 patients within 1 month of the ED visit was 10.6 visits for the usual care arm, 9.4 visits for the prescription arm, and 8.4 visits for the medication-dispensing arm. Rates of hospitalization per 100 patients were 2.4, 2.2, and 1.9, respectively.
Including indirect costs related to missed parental work, total costs per 100 patients were $27,100, $22,000, and $20,100, respectively. Total cost savings per 100 patients comparing the usual care arm with the medication dispensing arm was $7,000.
This study suggests that uniform prescribing or dispensing of ICS at the time of ED visit for asthma may lead to a decreased number of ED visits and hospital admissions within 1 month and provides substantial cost-savings.
Source: Andrews AL, Teufel II RJ, Basco WT, Simpson KN. A Cost-Effectiveness Analysis of Inhaled Corticosteroid Delivery for Children with Asthma in the Emergency Department. The Journal of Pediatrics, 2012; 161 (5): 903-907.e1.