Many may miss out on full benefit of asthma meds

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Many may miss out on full benefit of asthma meds

By Merritt McKinney

NEW YORK, Dec 24 (Reuters Health) - Inhaled steroids help asthmatics

control wheezing and other symptoms of the respiratory disease, but a

new report suggests that many adults with asthma are not getting the

most out of their inhalers.

The problem is not that doctors are not prescribing adequate doses of

inhaled corticosteroids, which can prevent the inflammation of asthma,

one of the study's authors told Reuters Health.

But for a variety of reasons--including how patients use inhalers and

flaws in the devices themselves--less medicine makes its way into

patients' airways than doctors intend, according to Dr. Allan T. in

from the University of Wisconsin-Madison.

" Proper delivery of this therapy is critical to its success, " in

said.

When prescribing inhaled steroids, " we must evaluate not only the

molecule--the drug--but the delivery system and the patient's ability

and willingness to use it, " in explained.

The inhaler, he said, " is not a pill where the only skill required to

deliver the medicine is to open the bottle and swallow it. "

in and his colleagues developed a model to estimate whether asthma

patients are receiving adequate doses of inhaled steroids. They based

their model on a review of studies published from 1966 to 2000 that

evaluated inhaled asthma medications.

Regardless of the type of drug or inhaler, patients taking inhaled

steroids to control asthma only receive " a fraction " of the medication

prescribed, the researchers report in the Journal of Asthma.

According to in, there are many reasons that patients are not

getting the full benefit of inhaled corticosteroids.

" The majority of patients don't use their inhaler correctly, and thus

they deliver only some or none of the intended dose, " he explained. He

also noted that most patients are not given a spacer, a device that can

improve the function of an inhaler. But even when they have a spacer,

most people do not use it, he added.

Another problem, in said, is that most inhalers are " inefficient and

prone to errors. "

Most importantly, patients may not use their inhalers as often as

recommended. Many patients do not realize that inhaled steroids are not

very effective at controlling asthma unless they are used on a regular

basis, regardless of whether a person has any symptoms, the researcher

continued.

" Receiving the benefits of the therapy requires a commitment to use it

regularly, " he said.

Patients need to understand that many people have problems using inhaled

steroids, in said. " If they are not absolutely comfortable with the

inhaler, they should demand more instruction, " he advised.

When patients get a prescription filled or go to the doctor, they should

ask their pharmacist and clinician to watch them use the inhaler to make

sure they are using the proper technique, in said.

He also pointed out that a doctor may be able to substitute an inhaler

that is easier for them to use.

One of the report's co-authors is an employee of Merck and Company in

Whitehouse Station, New Jersey, maker of the oral asthma medication

Singulair.

SOURCE: Journal of Asthma 2001;38:645-655.