Millions of Americans live with asthma, a chronic lung disorder that can’t be cured and can cause fatal attacks.
When you breathe in something irritating — the trigger might simply be cold air — your airway might overreact and tighten if you have asthma.
It can swell up and fill with mucus, causing you to cough or wheeze.
To prevent attacks, people with asthma commonly use a small pump or inhaler every day.
They breathe in a corticosteroid, sometimes combined with another drug, to fight the underlying issue that makes the airway overreact and tighten.
They also carry rescue inhalers to use when they are coughing or wheezing. These contain bronchodilators that open up the airway.
Because a daily inhaler delivers the medicine straight to your lungs, it is a safer strategy than corticosteroid pills, which affect more of the body and may have significant side effects.
But inhalers can also be hard to use and easy to lose.
The goal is to use the rescue inhaler no more than two times per year. But some people use them often, and others forget to carry them.
If you experience an attack without a rescue inhaler at hand, you can end up in an emergency room.
The ideal solution: a pill with few side effects to tame overreactions and make emergency rescue less necessary.
Breakthrough research is bringing that possibility closer, perhaps within a few years. Until then, people with asthma can try other new options.
A safer pill
Utilizing a four-year $2 million grant from the National Institutes of Health (NIH), a team of researchers from Columbia University and the University of Wisconsin, Milwaukee, have announced the creation of two compounds that calm the lungs in a novel way.
The team outlined the results from a series of animal and human tissue experiments in an April 25th article published in Molecular Pharmaceutics.
The goal is a “first-line therapy for patients with mild to moderate disease.” This is a group that now uses inhalers daily, Douglas Stafford, a study co-author, and director of the Milwaukee Institute for Drug Discovery, told Healthline.
The medications can be used in a pill that promises to be safer and more effective than other asthma remedies.
The team built on the discovery that the lungs contain receptors for GABA, a family of receptors targeted by anti-anxiety drugs — benzodiazepines like Xanax. Imagine saying “Down” firmly to a dog. That’s something like what GABA says to your body.
One key question: Could the team design compounds that would calm the lungs but wouldn’t reach the brain?
The goal of an asthma remedy wouldn’t be calming like benzodiazepines, which can be addictive and cause fatigue.
To work in pill form, the compounds also would have to survive a long series of obstacles. Each compound has to “target receptors in the correct tissues, make it into a pill, survive the digestive track, go into circulation, bypass the liver, reach the lung, stay out of the brain, and stay in the blood for a long time,” Stafford explained. “It was a lot to engineer.”
They said they effectively activated GABA, a calming signal, in muscles lining the airway and tissues in lungs that are part of the immune response that goes astray in asthma.
The action takes less than 20 minutes, Stafford said. He expects that people taking the new pill will probably still be carrying rescue inhalers.
The team expects to begin clinical trials within “a year or so.”
A smarter inhaler
Also in a year or two, we’re likely to see better inhalers, said Tonya Winders, president of the nonprofit advocacy group Allergy & Asthma Network.
More than 70 percent of people don’t use their inhaler correctly, Winders told Healthline.
In one standard design, you need to press down to release a spray, and breathe in slowly and deeply for about four seconds. Many people breathe in too quickly and the medicine tends to “get into the mouth or back of the throat, not the lungs,” she said.
The problem applies to both rescue and daily inhalers.
The ProAir Respiclick, a rescue inhaler Winders considers more effective, is already available. It delivers a powder into a chamber when you open up the top and hear a click. The powder is ready for you whenever you take a breath.
The industry is also getting ready to deliver “smart” inhalers with electronic chips.
They might have sensors that would read the air and alert users to triggers.
Other devices might clip onto current inhalers and help users know when they haven’t used it properly.
Daily inhalers might let users know if they haven’t taken their medication.
In addition, if the chips collect data that is shared broadly, this new technology could help researchers understand the disease. The data also could be used as proof for insurers that you used your device as recommended.
That could be important if you have a severe case of asthma and seek approval of a more expensive treatment.
New drugs for severe cases
Up to 10 percent of people with asthma are considered to have a severe form of the disease.
Around a third of these people don’t get enough relief from a daily inhaler, so prednisone pills, a corticosteroid, are also included in treatment.
Over time that approach is risky. It bumps up the chance of osteoporosis, diabetes, and heart disease, among other conditions.
So a new generation of drugs, delivered by an injection or infusion, has been developed to help people cut back on prednisone.
The medication was detailed in a study reported in the New England Journal of Medicine in late May. The research was led by Dr. Parameswaran Nair, professor of medicine at McMaster University in Canada.
In the study, injections of benralizumab, given to study participants either monthly or every eight weeks, did not produce any major adverse effects.
More than a third of the participants receiving the injections were able to cut their prednisone dose by 90 percent. About 20 percent of participants didn’t respond.
Regulators are evaluating the drug in the United States, the European Union, Japan, and other countries.
Specialty drugs — which require injections or infusions — are a fast-growing area of pharmaceuticals. However, they may cost thousands of dollars a month and insurers tend to require proof that they are needed. For patients with high-deductible plans, they may be out of reach.
Susan J. Wysocki, WHNP, FAANPPeer
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