About 23 million Americans have asthma, according to the Centers for Disease Control. That’s a lot of folks, but there’s good news too: After a steady increase in hospitalizations and deaths due to asthma -- what many experts feared was an “asthma epidemic” -- the number of asthma sufferers who’ve experienced such extremes has dropped by more than 22 percent over the last 10 years. That’s because during that time major breakthroughs in research and treatment have made it possible for asthma sufferers to control, and even avoid, symptoms better than ever. Here, the advances that have gotten us where we are now, and what to expect in the future.
Going on the offensive. For years, asthma treatments focused on reversing an attack. Today the goal is to prevent those attacks from happening through combination therapy, the use of inhaled corticosteroids (medications that can prevent the airways from becoming inflamed and hyper-reactive) in conjunction with long-acting bronchodilators (which open the airways). “We’re getting a much better handle on severe asthma now, and many people believe it’s because of the widespread use of inhaled corticosteroids in the last decade or so,” says Norman Edelman, M.D., chief medical officer at the American Lung Association. Making those drugs easier to use has become a top priority and has led to the development of dispensers that contain both types of drugs in one unit; the third such product, Dulera (mometasone furoate/formoterol fumarate dihydrate), was just approved in June), and joins two other combo meds, Advair (fluticasone/salmeterol) and Symacort (Budesonide/formoterol).
Arresting allergies. When some asthma patients are exposed to certain allergens, their bodies produce high levels of an antibody known as immunoglobulin E (IgE), which stimulates the release of chemicals which lead to an asthma attack . For people whose asthma is impacted by IgE and for whom inhaled corticosteroids don’t work well, the approval in 2003 of Xolair (omalizumab), the first biologic medication for treating asthma brought new hope. (“Biologic” means a drug is derived from parts of living organisms, such as proteins, genes, and antibodies.) Xolair is given by injection and blocks the action of IgE antibodies. Several other biologic drugs for treating asthma are now being studied, including one that could potentially ward off the actions of interleukins, immune cell messengers.
Turning up the heat. About 5 percent of people with asthma aren’t helped by even the most advanced medications, and for them attacks are life-threatening. Last year, the FDA approved a procedure called bronchial thermoplasty, in which heat is used to dissolve the excess smooth muscle[MR4] of those tissues involved in asthma, which is often the problem in this subset of asthma sufferers. This is accomplished by inserting a flexible tube called a bronchoscope into the bronchial tubes -- the tubes that carry air into the lungs after it’s been breathed in. In studies, bronchial thermoplasty has relieved asthma symptoms, reduced emergency room visits, and improve overall asthma control.
Ganging up on asthma. Why do asthma medications work so well in some people and not at all in others? Finding the answer is the goal of an exciting project called the Pharmacogenetics of Asthma Treatment (PhAT). Doctors at Harvard University, the University of Cincinnati and the University of Colorado are teaming together to identify phenotypes (the physical characteristics) and genotypes (the genetic characteristics) of different asthmatics in order to sort out which treatments work best for which types of asthma sufferers. “Several phenotypes have been identified already,” says pediatric pulmonologist Bradley Chipps, M.D., a spokesperson for the American Academy of Asthma, Allergy, and Immunology (AAAAI). “For example, there’s the early viral-induced wheezer, the infection-induced female asthmatic whose breathing problems begin in her 30s or 40s and who is usually overweight and not allergic, the aspirin-induced asthmatic who is the most severe of the group, and the allergic rhinitis/exercised-induced asthma patient who is the most common type.” In the works: identifying and grouping people by their gene patterns to see if those genotypes can predict who will respond best to different asthma treatments.
Tracking down triggers. Understanding why certain people are more likely to develop asthma than others could lead to the development of therapies that target these specific causes. Researchers are hot on the trail of better understanding three of them:
• Low levels of vitamin D. Recent studies suggest that vitamin D deficiencies are associated with impaired lung function and hyper-reactive airways, and that asthma medications, especially inhaled corticosteroids, are less effective in asthmatics whose vitamin D levels are low. There’s also a higher incidence of asthma in babies whose moms have low vitamin D levels. Many doctors now recommend routine blood tests for people with asthma to check vitamin D levels; for those with low levels, a daily supplement of vitamin D (up to 2,000 IUs)/ may be recommended.
• Poor air quality. The incidence of asthma tends to be higher among groups of people who live near busy highways; ozone and particulate matter in the air appear to be the culprits, by sensitizing the airways. “One study found that children who played more than two outdoor sports in areas with the highest ozone levels had the highest incidence of exercise-induced asthma,” says Dr. Chipps. To minimize exposure to asthma-causing pollutants, stay indoors whenever pollution or traffic levels are high. When they’re moderate, you may be able to exercise outside, depending on the asthma-management plan you’ve put together with your doctor. A more long-term approach is to encourage government officials to pass legislation to decrease pollution, an approach that’s worked with other irritants. For instance, when Scottish researchers examined hospital data from 2000 through 2009, they found that before Scotland banned smoking from public places (in March of 2006), hospital admissions for asthma were increasing at a rate of more than five percent per year; after the ban, the rate of admissions for asthma dropped by more than 18 percent per year.
• Painkillers. Recent research has found that between 8 to 20 percent of adult asthmatics experience bronchospasms after taking aspirin or other non-steroidal anti-inflammatory medications (NSAIDS). Asthmatics with chronic rhinitis or a history of nasal polyps are at greatest risk. And while children rarely have this reaction, there’s evidence that kids who were exposed to acetaminophen in the womb or who are given it early in life (for example, after receiving a vaccine) have an increased risk of developing asthma. What’s more, a new study from New Zealand found that the asthma risk is higher for teens who take acetaminophen (Tylenol) once a month or more. says Dr. Chipps. “This evidence of a relationship between NSAIDS and asthma isn’t as strong for children as it is for adults, but to be safe, the best pain- and fever-reducing medication for kids appears to be ibuprofen,” says Dr. Chipps.