The Treatment of Asthma - Essay Example

Critical Appraisal of a Review Article Involving Long-acting Beta-2 Agonist (LABA) versus Leukotriene Receptor Agonist (LTRA) as Second Line Therapy for Patients with Persistent Asthma Treatment of asthma is aimed to alleviate or suppress inflammation, and optimize lung function and attenuate AHR. Currently there are numerous patients whose asthma symptoms are eased by the use of inhaled corticosteroids alone. Unfortunately, in some cases, symptoms persist. Normally, physicians before even doubling dosage would review other possible causes of persisting symptoms. They would even teach their patients to inhale medicine properly for optimum delivery. However when this still continues, they prescribe second-line therapy such as a long acting beta-2 agonist (LABA) or a leukotrine receptor agonist (LTRA). LTRA is the main subject of this paper by Currie, et al. This study is focused because it clearly states its target population of concern which is patients with persistent asthma. Secondly it addresses the issue of what physicians turn to when asthma is persistent. Specifically, these are LTRA and LABA. These two play a very important role as they are legally administered and known second line therapy. In the UK, their guidelines state that in the first instance, LABA should be administered as a therapeutic trial. If this is unsuccessful, then this is the time to administer LTRA. Third, outcomes are clearly defined. Physicians give inhaled corticosteroids when a patient is diagnosed with asthma. For persistent symptoms, they choose to introduce LABA. This is known to be more effective than an increase in dosage of the inhaled corticosteroids. Additional therapy with LTRA is presented to be more effective than LABA in its overall efficacy. Only appropriate, related and relevant papers and journals were included in this review article. In fact, in the material and methods section of this paper, the researchers pointed out that they searched for suitable trials with its relevance evident in the title and abstract. This therefore implies that no literature included used LTRA or LABA as a secondary topic. Researchers focusing on these were included and not those that just merely mentioned the two. The data base used MEDLINE Clinical Evidence, Cochrane Library and EMBASE database, are supported by reputable organizations. The research for significant literature also had key guidelines limiting searches to about 11 words. This definitely narrowed down the search and only produced crucial and relevant journals that are directly related to the research topic. A statistical analysis was not used. Certain data from the studies were taken and reviewed. This included the study design, mean inhaled corticosteroid dose, and type of randomized treatments used. For the effect, the results from different papers that were taken were effect in FEV, PEF, quality of life, inflammatory biomarkers and airway hyperresonsiveness (AHR). The effect of LTRA on these factors will be measured because asthma is considered controlled when such things are positively affected. When combined, all the studies produce consistent results with regard to LTRA. The 9 trials that were included in the review were all able to evaluate the effects of LTRA and LABA as second line therapy to inhaled corticosteroids. This review article showed that administering LTRA as a second line therapy was only as effective as LABA. In most trials, LABA proved to be more effective in lung function than LTRA. On the other hand, for inflammatory biomarkers such as nitric oxide, LTRA proved to be superior to LABA. Exacerbation was not significantly different when LABA or LTRA was given. The researchers gave a very useful diagram at the end of the article. This diagram aims to help physicians prescribe the right second line treatment (either LTRA or LABA) to patients based on symptoms and airway status. This is because from this review article they learned that at some instances, one may be more effective than the other. Overall, this review article had been very relevant and significant for physicians and patients alike. This will benefit and help ease treatment for asthmatic patients. Generalisability is strong since it tackles patients with asthma and most patients receive the same treatments. Harms and costs of the subject were not mentioned in this review however. Although we know that the study benefits treatment of patients with asthma, no mention of how it could economically improve maintenance of asthma patients was included. The negative or adverse effects of LABA or LTRA were not mentioned as well. We know that they are better alternative to increasing corticosteroids, unfortunately their specific side effects were not given much thought. This could be an area where future studies can look into and expand this current review article. Since it has already been established that LTRA and LABA are more effective, the negative outcomes of these should be given a closer look and should be studied for its harmful properties. Critical Appraisal for an Original Study Involving Administration of Leukotriene Receptor Antagonist or Theophylline to Patients with Persistent Asthma treated with Inhaled Corticosteroid Asthma is one of the leading diseases causing pain and discomfort among many individuals today. It is a chronic inflammatory disorder affecting the airways and the alveolar tissue. In spite of the current effective treatment, researchers and physicians still continue to find better and more effective ways that have fewer side effects to help asthma patients. One study by Dempsey and his colleagues centered on the effect of adding zafirkulast or theophylline to a treatment already consisting of inhaled corticosteroid. Specifically, they phrased their question aiming to evaluate the effect of low dose theophylline or antagonist of leukotrine receptors to the treatment of asthma patients. These asthma patients are already receiving either a low to medium dose of corticosteroids that are inhaled. Patients who participated in the study were from ages 18-65. They have been established to have mild-moderate persistent asthma. Those who were qualified to participate were receiving the same doses of BDP. The Tayside Medical Ethics Committee gave permission to use human subjects. The intervention involved, as the objective implied, administration of oral drugs such as zafirkulast and theophylline. The primary outcome variable is bronchial hyperresponsiveness and they measured this outcome by spirometry of release of nitric oxide. Before thoroughly appraising the paper in a critical manner, it has to be mentioned that there are key components in this study that helped in understanding the subject matter at hand. The paper was, in a way, technical with all the terms, the names of the drugs, etc. However, the authors explained the usage and prevalence in the market of such drugs that it became easier for the reader to understand this. Another important component is the diagram that showed the study design. As will be discussed later, this study involved placebo-controlled three-way crossover. This may be confusing but looking at the diagram may give the reader a better grasp of the study design. This paper is focused in terms of population studied, the intervention given and the possible outcome that it may bring. The abstract is very straight forward, mentioning that the participants in the study involved 24 patients with mild to moderate asthma. This right away excludes people with severe asthma and those with complications. There are a few setbacks to this though. In the abstract, it did not immediately mention that these are patients belonging to the 18-65 age bracket. You will just find this information within the paper. Another criticsm is that the time these subjects acquired the disease was not specified. The age range is too wide and the only measurement of ashma required was that they are considered to be on the low-moderate scale. Lastly, length of use of inhaled corticosteroid was not taken into consideration. The dose per day was defined but not the time that these patients have been using medication. This could be a problem since some may have been exposed longer to the drug and for hat reason, prolonged exposure could be a factor. Other than these, the study may still be considered sound and focused on its population which are asthma patients using corticosteroids. For intervention, the authors clearly focus on 3 treatements. They are: Treatment 1: beclomethasone 100 ug/d for the first 2 weeks + 400 ug for the following 2 weeks; Treatment 2: beclomethasone 100 ug/d + 400 ug/d + zafirkulast, 20 mg bd; Treatment 3: beclomethasone, 100 ug/d + 400 ug/d + theophylline, 200-300 mg bd. Placebo washout was also enforced between treatments ensuring that the exposure did not cause results in the following treatment. To measure outcome and effectiveness, the authors chose to measure bronchial responsiveness. According to them this is a primary outcome variable crucial to such a study because it greatly reflects the underlying inflammatory process in asthma. Bronchial hyperresponsiveness is also considered more sensitive than typical lung function variables. Assignment of treatment intervention to the participants was randomized. The details of this randomization was indicated under materials and methods. At the same time, all participants who entered the trial were properly accounted for at the conclusion. Thirty two participants originally joined. It was discussed in the results how 8 participants dropped out. Most subjects did not finish the trial due to worsening of their asthma. The authors did not however explain if there was a connection with their study with the reason as to why the participants withdrew. Unfortunately, one will not know if the adverse effects of their trial could have possibly caused the worsening of the participants’ condition. The study was conducted in a single blind, double dummy method, ensuring that there is no confounding. Since it is a single blind only, the one who administered the medication knew the treatment group of the participants. Being a highly quantitative study, results were not affected by this. The benefit of the double dummy was t hat the use of placebo washout in between active trials made sure that that there was no confounding with the drug exposure or that the drugs did not become more potent because of the treatment. The participants, in a way, were given to “wash out” the chemicals before engaging in another treatment. The screening visit guaranteed that all individuals who participated were similar at the start of the trial. They had their metacholine PD20 measured on 2 separate occasions making certain that there was consistency. In addition, there were study visits uniform to all participants, regardless of treatment group. Even the time that specific samples were taken was uniform. This guaranteed that subjects were treated equally and confounding could not have happened. For the results, significant difference was reported in all areas measured. Bronchoprotection was seen in all treatment groups comparing them to the placebo controlled pretreatment. The group treated with becomethasone monotherpay (Group 1) improved at p Read More