Alvesco

Anti-inflammatory drugs

Medications that treat the underlying inflammation associated with asthma are known as controller medications and include inhaled corticosteroids (ICSs), leukotriene modifiers, anti-immunoglobulin E (IgE) therapies and oral corticosteroids.

ICSs

ICSs are currently considered to be the most effective anti-inflammatory medications available for the treatment of persistent asthma.1 They improve lung function and asthma symptoms,2 and reduce the frequency and severity of exacerbations2 as well as airway hyperresponsiveness.3

ICS monotherapy is recommended by GINA as the first-line treatment option for most asthma patients. Furthermore, almost all physicians agree that ICSs are the 'gold standard' treatment for asthma.4

For the treatment of asthma, an ideal ICS should:5,6

  • Be able to enter and treat the small airways
  • Have high receptor-binding
  • Have high pulmonary deposition
  • Possess prolonged lung activity
  • Reduce the need for rescue medication
  • Improve pulmonary function
  • Minimize side effects.

Although ICSs are the cornerstone of asthma therapy,1 physicians should be mindful of the side effects that are associated with long-term ICS use (Figure 1). 

152 fig 1ICS side effects
Figure 1: Local and systemic side effects may be associated with ICS use


Alvesco®  is an ICS with specific pharmacology and a good tolerability profile that can be used as monotherapy or in combination with long-acting β2 agonists (LABAs).

Leukotriene modifiers

Leukotriene modifiers block the activity of leukotrienes, which are signalling molecules that promote bronchoconstriction. They may be used as an alternative treatment for patients with mild persistent asthma who are unable or unwilling to use ICSs, or who experience intolerable side effects with ICSs, such as persistent hoarseness. Leukotriene modifiers are not as efficacious as low-dose ICSs.1

Anti-IgE therapy

Anti-IgE therapy is a treatment option limited to patients with elevated IgE serum levels. It is currently indicated only for patients with severe allergic asthma who are uncontrolled on ICS.1

Oral corticosteroids

Oral corticosteroids possess anti-inflammatory and immunosuppressive properties, but their use is reserved for patients with severe uncontrolled asthma, due to side effects associated with their use.1


References

  1. The Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention. Available from: http://www.ginasthma.org/. 2012
  2. Pauwels RA, Lofdahl CG, Postma DS, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. N Engl J Med 1997;337:1405-11.
  3. Long-term effects of budesonide or nedocromil in children with asthma. The Childhood Asthma Management Program Research Group. N Engl J Med 2000;343:1054-63.
  4. Canonica GW, Baena-Cagnani CE, Blaiss MS, et al. Unmet needs in asthma: Global Asthma Physician and Patient (GAPP) Survey: global adult findings. Allergy 2007;62:668-74.
  5. Zitt MJ. Properties of the ideal corticosteroid therapy. Allergy Asthma Proc 2005;26:173-82.
  6. Cerasoli F, Jr. Developing the ideal inhaled corticosteroid. Chest 2006;130:54S-64S.

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