Why some inhalers can make asthma worse?

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asthma inhalerThe work of researchers at Wake Forest University Baptist Medical Center may shed new light on why some inhalers can worsen asthma.

Raymond Penn and Matt Loza, scientists in Wake Forest's School of Medicine, led a research team studying the effect of a class of drugs called beta agonists - often found in inhalers - on cells collected from healthy people.

They found that the drug increases a type of white-blood cell involved in immune-system defense. These Type 2 T-cells are thought to contribute to such health problems as asthma and even lupus. They're seeing similar results in preliminary research of cells collected from asthmatics.

Penn and Loza's research was recently published online in the Journal of Allergy and Clinical Immunology and will be printed in an upcoming issue. Their research may lead to better formulations of asthma therapy in the future, Penn said.

Inhalers containing beta agonists are often used by asthmatics to open up constricted airways during attacks. More severe asthma is often managed on a daily basis by a combination of medications. One combination is an inhaler that contains beta agonists and cortico-steroids, which decrease inflammation.

The work by the Wake Forest researchers "gives more support to that idea of combination therapy," Loza said. "It's not an option to not use an inhaler."

One of the most popular combination inhalers, Advair, recently came under scrutiny after a Food and Drug Administration decision required that the medication be sold with a warning label. The medication is made by GlaxoSmithKline. A company study found that people taking a related medication showed a "small but significant increase in asthma-related deaths," an FDA report said. The FDA revised the labels of it and similar medications earlier this year to add a "black box" warning, the strongest the agency can put on prescription drugs.

"Unfortunately that has sort of obscured the fact that inhalers are indispensable for people with asthma," Penn said. "Some people can take them and they're fine, but in some people, there seems to be a loss of the effectiveness of the drug."

But Advair and other mainstream combination inhalers are usually still the best treatment option for serious asthmatics, and there are clinical trials looking at the safety of these kinds of drugs, Penn said.

People with milder asthma who use a beta agonist inhaler during attacks should also continue to - such occasional use isn't going to exacerbate their breathing problems over the long term, Penn said.

Asthma is the chronic inflammation of the airways, often worsened by allergic triggers.

"The one way to think about asthma is that the immune system is over-reacting to something in your lungs," Penn said. "And usually it's a an inhaled allergen, like ragweed, pollen or dust."

Asthma affected about 20.5 million adult Americans in 2004, according to the National Center for Health Statistics. It is the most common chronic childhood disease, according to the American Lung Association, affecting 6.2 million children under 18 in 2004.

The recent research to come out of Wake Forest also suggests that similar chemicals are associated with heart disease, lupus and chronic stress may cause inflammation.

source - Journal Now