Asthma combination therapy

The Easyhaler (by Orion Pharma, Finland) and the Clickhaler (by Innovata pic, United Kingdom) are available at present in some European markets. Unlike the DPIs described earlier, these two reservoir-type inhalers meter the dose when the patient presses the top of the device similar to actuation of a pressurized metered-dose inhaler. Both devices contain a dose indicator, which is standard for reservoir multidose DPIs. Recently, Innovata presented the Twinhaler for asthma combination therapy, a new development based on the Clickhaler. This device does not require the combined drugs to be formulated in one powder blend but delivers two powder formulations from two reservoirs into one airflow path. 

O Byrne PM, Bisgaard H, Godard PP et al. Budesonide-formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med 2005 171 129-36. 

Their antihypertensive efficacy is comparable to that of (3-adrenergic blockers and angiotensin-converting enzyme (ACE) inhibitors. The choice of a calcium channel blocker, especially for combination therapy, is largely influenced by the effect of the drug on cardiac pacemakers and contractility and coexisting diseases, such as angina, asthma, and peripheral vascular disease. 

Combination Therapy for Asthma and Chronic Obstructive Pulmonary Disease, edited by R. J. Martin and M. Kraft... 

Seretide is a combination therapy consisting of fluticasone propionate and salmeterol. It is marketed by GSK for the treatment of asthma. Fluticasone is the chiral component and a steroid derivative. 

Berger WE, Fineman SM, Lieberman P, Miles RM. Double-bhnd trials of azelastine nasal spray monotherapy versus combination therapy with loratadine tablets and beclomethasone nasal spray in patients with seasonal allergic rhinitis. Rhinitis Study Groups. Ann Allergy Asthma Immunol 1999 82(6) 535-41. 

In an open study in six adults with mild to moderate asthma, clarithromycin significantly reduced methylprednisolone clearance, thereby increasing the risk of steroid-induced adverse effects (160). In contrast, prednisolone clearance and mean prednisolone plasma concentrations were unaffected. Frank psychosis due to combined therapy with prednisone and clarithromycin has been reported (161). 

Numerous studies have shown that the inhaled /32-agonists administered by MDI plus holding chamber provide a similar outcome in severe acute asthma as administration by jet nebulizers. Proponents of administration by MDI plus holding chambers argue that it is more cost-effective and so should replace nebulizer therapy. However, appropriate cost analyses have yet to be performedNor have there been comparisons in the most severe subsets, where combination therapy and continuous nebulization are recommended. Current practice should be based on the comfort level of the clinical staff until sufficient data are available to warrant a wholesale recommendation of one method. 

Donohue JF, JA Ohar. 2001. New combination therapies for asthma. Curr Opin... 

Kerstjens HA, Engel M, Dahl R, Paggiaro P, Beck E, Vandewalker M, et al. Tiotropium in asthma poorly controlled with standard combination therapy. N Engl J Med September 27,2012 367(13) 1198-207. Epub September 2,2012. 

Beta adrenergic agonists also exert bronchodilating effects. These drugs are thus often used in conjunction with theophiline in asthma therapy. A drug that combines both moieties, reproterol (40), has interestingly proved... 

Leukotrienes are rapidly produced and released during a Type I reaction (Fig. 3). They are responsible for a massive bronchoconstriction in allergic bronchial asthma and attract leukocytes, thus being proinflamma-tory. Consequently, antagonists of the LTC recqDtor have been proven useful in the therapy of bronchial asthma, often in combination with bronchodilators (example montelukast). 

The addition of ipratropium bromide to inhaled p2-agonist therapy in acute severe asthma improves pulmonary function and decreases hospitalization rates in both adult and pediatric patients.31 The benefit of combining ipratropium and albuterol appears to be greatest in moderate to severe exacerbations, and the combination should be considered first-line therapy in severe exacerbations. 

Aerosolised medicines have been used for centuries to treat respiratory diseases, with inhalation therapy for the airways focused primarily on the treatment of asthma and chronic obstructive pulmonary disease (COPD). The development of new products for delivery to the lungs for these respiratory diseases includes new steroids and beta agonists plus combination products featuring both agents. New classes of anti-asthma medication are also being developed for inhalation with the aim of delivering them directly to the inflamed airways. 

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