Effects on
Asthma Medication cont..
But doctors also recognize that
asthma may not behave the same way among people who have
different body types. With a variety of asthma medications on the
market, what kinds work best for lean people and what kinds work best
for obese people? The answer may be different for each group.
A new asthma medication
study suggests that people who are overweight or obese may have better
results with the prescription pill sold as Singulair than with a type of
inhaled steroid, while leaner people may have better luck with an
inhaled steroid, called beclomethasone and sold as beclovent, vanceril
and other brand names. The findings appear in the new issue of the
European Respiratory Journal.
"It is increasingly recognized
that obese people are more prone to develop asthma, but there is
no information about whether obesity influences people's responses to
particular asthma medications," says lead author Marc
Peters-Golden, M.D., professor of internal medicine and director of the
Fellowship Program in Pulmonary and Critical Care Medicine at the
University of Michigan Medical School.
"Our findings are the first to
suggest the possibility that obesity might be a factor that influences
how well asthmatics respond to particular medications," Peters-Golden
says.
Singulair is the brand name of
montelukast sodium and is sold by Merck & Co., which funded this study.
Researchers looked at data from
four previous multi-center, randomized clinical trials from 3,073
patients with moderate asthma. The data included the patients' responses
to Singulair/montelukast, a beclomethasone inhaled steroid and a
placebo, and the participants' body mass index numbers, which placed
them in the categories of normal, overweight and obese.
In general, the severity of
people's asthma was found to be greater among those in the
overweight and obese groups, which supports findings from other studies.
In addition, the inhaled steroid
was found to be better than Singulair at increasing the number of asthma
control days (ACD) among people in the normal weight category. An ACD is
defined as a day with no more than two puffs of an inhaler, no
night-time awakenings and no asthma attacks.
On the other hand, the inhaled
steroid resulted in a reduced effect in the percentage of ACDs among
obese people in the study -- that is, the benefit of the inhaled steroid
declined with increasing body mass index.
In contrast, the positive impact
of Singulair did not decrease in obese and overweight people when
compared to its impact on people of normal weight. The research also
suggests that the higher a person's body mass index, the greater his or
her response to Singulair compared to a placebo, a pill with no
medicinal benefit. This is an indication, Peters-Golden says, that obese
and overweight people may in fact respond better to this medication.
Still, he is not inclined to
suggest that doctors change the way in which they prescribe medication
-- not yet, anyway.
"Our study looks back at
material from previous trials. I'd like to see a prospective study in
which lean patients and heavy patients are enrolled at the outset, and
you compare both types of medications in both groups," Peters-Golden
says. If verified by other studies, this insight may help physicians to
better tailor medication regimens to meet individual patient needs.
Peters-Golden also notes that
much research about asthma and other conditions is exploring the
possibility that genetic factors might explain individual variations in
responses to medications. He says it is likely that a variety of
factors, including genetic ones and acquired factors such as weight,
combine in a complex and intertwined manner to influence a person's
reaction to medications.
Information about Singulair/montelukast:
This medication, usually taken once a day, is a type of leukotriene
antagonist -- that is, it blocks leukotrienes in the body. Leukotrienes
are chemicals in the human body that can affect the breathing passages.
Information about the beclomethasone inhaled steroid: Beclomethasone is
a steroid that prevents the release of substances in the body that cause
inflammation. Inhalation of beclomethasone prevents asthma attacks and
other conditions involving inflammations of the lung tissues.
In addition to Peters-Golden,
other authors of the study were A. Swern, S.S. Bird, C.M. Hustad, E.
Grant and J.M. Edelman, all of Merck & Co.
One of Peters-Golden's primary
research interests involves leukotrienes, and he has consulted for and
spoken on behalf of a number of pharmaceutical companies, including
Merck & Co.
- - - -
REFERENCE: European Respiratory
Journal, Vol. 27, No. 3.
CONTACT: University of Michigan
Health System Media Relations -- Katie Gazella or Nicole Fawcett,
734-764-2220, kgazella@umich.edu or nfawcett@umich.edu
Asthma is a complex disease that is influenced by multiple
genetic, developmental, and environmental factors, which interact to
produce the overall condition.
Asthma Information
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