Behind the Headlines: Can a pill match inhalers for asthma?

Asthma pills can be just as effective as inhaler treatment, according to news reports.

Asthma treatment was studied in 658 patients beginning therapy (Photograph: SPL)
Asthma treatment was studied in 658 patients beginning therapy (Photograph: SPL)

University of East Anglia researchers found that adherence to a pill containing leukotriene receptor antagonists (LTRA) was 'vastly improved' compared with inhaled steroids. In addition, the pill controlled symptoms as well as inhaled glucocorticoids.

NICE recommends inhalers as first-line treatment and previous studies have raised doubts about the efficacy of LTRA pills.

What did the researchers find?
The UK researchers followed 658 patients beginning asthma controller therapy at 53 UK general practices over two years. They compared LTRA pills with inhaled long-acting beta-2 agonist in patients with uncontrolled asthma already taking inhaled glucocorticoids.

The researchers found that patients taking LTRA pills had an equivalent quality of life to those on standard therapies after two months.

Should prescribing change?
Lead author and Norfolk GPSI Dr David Price said: 'We found that adherence to treatment was vastly improved - by as much as 60 per cent - when patients were given the once-a-day LTRA tablets.'

But researchers urged caution in interpreting the findings. Equivalency of LTRAs with standard treatments could not be proved at two years due to excessive variation in effective-ness of treatments by this time.

The lack of placebo comparison, open-label (non-blinded) treatments and the mixed real world participants may have biased results, they said.

Samantha Walker, director of research and policy at Asthma UK, said the study provided preliminary evidence that pills could provide a 'realistic, alternative choice of treatment for some of the 4.3 million adults with asthma in the UK'.

'Our advice to people with asthma would be to continue taking their medicines as prescribed,' she said.

Informing patients
  • A non-steroid pill for asthma is as effective as standard inhaler treatment.
  • Patients were also more likely to take the pills than the inhaler.
  • Doubts remain over validity of the findings as use of pills or inhalers could not be blinded.
Stephen Robinson

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NEJM 2011; 364: 1695-1707

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