Asthma Pills Work as Well as Inhaled Steroids

In a study pill asthma compared with commonly prescribed inhaled steroids, British researchers found that oral drugs as effective as inhaled drugs.

Oral drug, known as leukotriene-receptor antagonist, “has shown similar efficacy and cost and better compliance, and should be considered for all patients, not as a last resort, but as an option for patients,” said study co-author Dr Stanley Musgrove., senior research fellow at the University of East Anglia in Norwich.

“Every different patients will have their own problems that are important to care for them: their adherence to different medications, how well they feel that different drugs work for them, their concerns about different drugs, side effects may be small, and so forth, and all these should be considered when doctors and patients make decisions about the best medicine, “he said.

The results published in the May 5 edition of the New England Journal of Medicine.

This study was designed to be what the researchers call a “pragmatic” trial, which more closely mimic the way people are using drugs in real life as opposed to the strict rules of clinical trials, according to Musgrove.

The researchers recruited 650 people with mild to moderate asthma. The study volunteers were between the ages of 12 and 80, and have inadequate asthma control or quality of life disruption due to asthma symptoms.

Volunteers were randomly assigned to groups. One research group compared with leukotriene-receptor antagonist (Accolate and Singulair) for inhaled corticosteroids as first-line treatment for asthma. Another group of studies compared people who are already taking inhaled steroids are then added to both long-acting rescue medication (known as NET) or leukotriene-receptor antagonist (LTRAs).

Patients were allowed to comply as they wish and change drugs they need, Musgrove said.

Results in two months show that LTRAs also equally effective for inhaled corticosteroids when used as first-line treatment and for consumed when used as an additional treatment. After two years, the effectiveness of these two similar treatment but the researchers noted that “equality has not been proven.”

Primary measure of effectiveness of the drug ‘is the Mini Asthma Quality of Life Questionnaire. This quiz has a 15-item total score between 15 to 105, with higher scores showed less decline in asthma. Increased by an average score of 0.8 to 1 point in the trial arms. Asthma control and frequency of asthma exacerbations were similar between the groups.

Musgrove said there was no significant side effects were reported for each drug. However, in 2009, the U.S. Food and Drug Administration asked drug makers to add warnings to labels LTRA their medication because of serious side effects behavior, including thoughts of suicide and depression in some people taking the drug.

Risk inhaled steroids for asthma include hoarseness, thrush, sore throat, and bone density may be reduced.

In terms of cost, in 2010 British study that compares the cost of the two therapies
to control asthma LTRAs initial finding that the price is “higher” than the inhaled steroid.

One expert says the latest study comparing the effectiveness of inhaled steroids LTRAs and underlines the need for individual therapy.

“The findings of the study does not make me change my mind. It is asserted that there are various options, and no one answer for everyone,” said Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital and Medical Center in Detroit.

“The National Institutes of Health has issued guidelines for the management of asthma, and many a literature review to go into setting those guidelines which recommend inhaled corticosteroids are tried first. And, it is my experience that I get good control with more patients using inhaled corticosteroids,” he said.

“But if someone is having difficulty using the inhaler on a regular basis or they experience side effects, then I’ll think about changing their medication,” he added. “But, there is no medicine that will help everyone, and no treatment without risk.”

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We"ll see, I guess

On the radio they were talking about kids and weight and body image and eating habits and all the rest, and I couldn’t help but wonder: Why is it such a big deal? Am I really that naïve? Clueless? Stupid?

I just can’t understand why it’s so hard. And I’m a picky eater! I would think of anyone out there, I’d be in the position to judge. Which is not to say pass judgment, but rather I’m in the position to say if it’s a big deal or not.

I’m picturing my hypothetical, unborn and un-thought-of yet child. Or children, I suppose. But in my head I think of her as Gidgit and there’s just the one. As a side note, I think it’s probably pertinent to say that know the source of that particular nickname. Well, okay wait. I’m not completely uncultured. I know Gidgit was one of Sally Fields’ breakout roles way back when, so technically I know two sources. But that’s not what I think of first when I think of the name Gidgit.

What I remember is much further down on the culture scale. It’s from an episode of Roseanne. Remember when Jackie tells her mother that she’s pregnant? It’s supposed to be this big shock, and as part of the whole “I’m pregnant” hurrah, she continues by saying, “And if it’s a girl, I’m going to name her Gidgit.”

Of course, in the episode it was funny because the mom already found out, and Jackie was disappointed because her surprise was spoiled, but for some reason that name stuck in my head as generic-unborn-baby-girl-name. And I’ve latched onto it because it provides a way to refer to my someday-child by a name instead of “It.”

At any rate, I just don’t think it’s going to be that hard when it’s my turn to take responsibility for nourishing another human being. On the radio, the caller lamented over her own problems with body image growing up. She admitted that it made her hesitant to talk to her daughter about the issues in case she (the mother) said something that was unintentionally tainted by her own experiences.

Is it my security in my own body that makes me so self-assured?

It could be, but I think not. I am—for the most part—relatively secure, and have been for the whole of my life. But I just don’t think my security is the reason behind my certainty.

I think it has to do with my journey along the road of pickiness. I grew up an extremely picky eater, continue to be very selective in my eating to this day—to the point that I annoy myself, truth be known—and my dietary choices have been much scrutinized for the entire 32 years of my existence.

There is, to put it bluntly, an implausible fascination with any food item that does or doesn’t pass my lips. Not just a fascination, but also a running commentary to the world at large by anyone in my general proximity. “She’s eating carrots!” “Noodles again!” “Mmmm, mashed potatoes!” Healthy, frozen, unhealthy, canned, preservative-full and -free. . . it doesn’t matter. Nothing gets by the masses.

I’ve stopped trying to respond to this confounding dialogue. There really isn’t an appropriate response, and the inappropriate ones just leave me feeling like a jerk. So I smile at their keen observation and continue my meal while doing my best to avoid eye contact.

But it’s been this journey that has lead me to a point today in which I feel utterly secure in my original statement that it just isn’t that big a deal. I am already assuming that Gidgit will be picky, at least to a point, but I’m also already planning how to handle it. I’m making plans based on my experience and what I wish could have happened.

First and foremost: things would have gone a whole lot easier growing up if we could have pinpointed a conceptual theme to my pickiness. Two themes that go hand-in-hand, actually: I’m a purist. Texture matters.

I’m a purist. I like foods in their natural state (or, in the case of veggies, steamed with little to no sauce or garnishing). I love vegetables. I also like a lot of meats, but if protein weren’t an issue I could probably live as a vegetarian and be perfectly happy. As long as being a vegetarian meant getting to have Fillet Mignon every blue moon. Ha.

I do love vegetables, a pretty unusual variety for a “picky person,” but I don’t like them prepared all different ways. I could probably eat steamed broccoli until I explode, but don’t try serving me broccoli with bread crumbs or inside a breakfast burrito or . . . well, maybe broccoli isn’t the best example. I’m drawing a blank on different ways to serve it. But still, you can catch my drift. I can’t even count the number of times I heard this:

“But you like this! It has _____ (e.g., broccoli) in it!”

To which my only response is: “So?”

I don’t care that I like broccoli, or green beans, or corn, or peas . . . whatever. Don’t mix them in anything!

Conceptually: I like my foods pure. By themselves. Not mixed together. Even, perhaps especially, when it comes to foods I enjoy (like all of the above listed vegetables). That doesn’t mean they go together. Vegetables and other kinds of foods I like don’t usually go together either. It is never okay to mix corn and mashed potatoes, by the way.

This concept has been a part of me longer than I can remember. It is as much me as my brown hair and stubborn charm. Identifying it and accepting it would have avoided many a dinner fight, subsequent “leave the kid at the table until they take one bite—they’ll crack eventually,” and ultimate conclusion, “Sigh. Go ahead and go to bed, I guess.” Stubborn to a fault, I also had the patience of Job. “Just take one bite” never worked. Not even once.

And I think my knowledge about this, and my other conceptual issues, will only help me with Gidgit. Because wouldn’t it have been great to have been encouraged to verbalize why I didn’t like something?

That isn’t a reproach against my parents. I’m just saying: wouldn’t life have been much better if we hadn’t been fighting at the dinner table so much?! Imagine the peace if we’d just figured out the theory behind my so-called bizarre pickiness. After so many years of frustration (“What? I thought you liked _____?”)(because no one could keep my eating likes and dislikes straight—it just seemed completely random), I would hope I have at least one tidbit of knowledge to pass along to Gidgit.

The tidbit is in the why. I now know there are many types of pickiness out there. Taste. Texture. Smell. Principle (I don’t eat veal on principle; I’m sure the taste is excellent, but I can not condone the treatment of the calves).

In the house I grew up in, the why didn’t matter. Why I didn’t like something was irrelevant. Someone (usually my mother) had prepared a meal, “It’s not poison!” and “There’s nothing wrong with it!”, so there was no reason why I couldn’t eat it.

That’s true. There was no reason why the food was bad. Except that I was morally against the concept of it. Stew. Casserole. Chunks. In my mind, I knew that was the problem, but we didn’t talk about it. You know. We didn’t talk about it rationally.

I’m ready to not take personal offense to Gidgit’s reasoning why. I’m ready for Gidgit to change her mind, and like (or not) something now that she did (or didn’t) like then.  I feel like I’ve always been the same, but I know it seemed that I changed my mind at random, and that was the most galling part to my parents.  Unfortunately, I think it was just too complicated to understand in the hectic world of “Well, this is what’s for dinner, so deal with it.”

I believe it’s simply a matter of options. That’s what “they” say too . . . whoever “they” are. But they say that you should give your child a choice so they can feel in control. I like that idea. But I think it will be a matter of art and paying attention and plain blind luck when it comes to choosing which options to provide. Both should be healthy, but they need to be different enough to start learning concepts even when Gidgit is too little for helpful verbalization (“Eww, yucky!” really isn’t helpful).

So—always only giving healthy options—why would someone give two options that are both conceptually the same—perhaps prepared meals he or she is morally against? Between sewage and blended sewage . . . what would you choose? If Gidgit smells sewage when served a plate of asparagus, well my response is that an adult can lead a healthy life without ever having eaten asparagus. If it’s that big of a deal, then she doesn’t have to have it.  And I certainly won’t expect her to eat a dish that includes asparagus, if asparagus is the concept she’s against.

Because in my house it will never be a sin to choose broccoli over asparagus, to choose asparagus over cauliflower, to want cabbage instead of green pepper, or to want green pepper instead of cucumber. FYI: I love all of those vegetables. But I don’t like cauliflower raw and I do like green pepper raw or sautéed. I detest cabbage raw, love it cooked. So giving me a choice between raw cabbage and sautéed green pepper . . . it’s not really a choice. But giving me a choice between sautéed green pepper and a bag of Doritos . . . I can tell you that now in my 30s I pick the healthy one, but I really couldn’t tell you what I would have chosen as a teenager.

What I can tell you is that I know at that time I couldn’t be trusted to make the right choice. When presented with options, and if the options include junk, I’d wager most teenagers and younger would go for the sugar, the salt, the preservatives. Like moth to a flame, they’re magnetically drawn to them.

So, ding ding ding! This is why I think the radio caller was making an issue where there wasn’t one. Why not just remove the temptation? No junk food. Is it that hard to only present healthy breakfast options? Plain wheat flakes or cereal with almond and fruit chunks? With or without milk. Yogurt on the side, fruit on the side, vegetable on the side (I guess, although personally I think that’s weird). Glass of milk, glass of O.J., class of cranberry juice. “On the side” is a big deal to me because I have such an aversion to anything mixed. Which is to say, some foods can be mixed, some absolutely can not. I always want to do it myself.

Back to the weird. That’s important too. Who cares if it’s weird to eat sliced cucumber in the morning with breakfast (on the side)? What does it matter? I’ll never forget one of the first dinners I made for my husband while we were dating: spaghetti with Ragu sauce, and for a vegetable—obviously on the side—I chose my favorite: broccoli. It sounded good that night, and didn’t seem weird to me, but I remember he thought it was about the oddest combination I could have come up with. Again, I’ve got to come back with: what difference does it make? Broccoli is a healthy vegetable. Just because Marie Callender doesn’t pair a spaghetti meal with broccoli for a vegetable doesn’t make it wrong. Good heavens!

I still don’t know if I’m naïve, clueless, or stupid.  Perhaps all three, perhaps none.  I certainly hope Gidgit doesn’t embarrass me by going into a detailed account of why she won’t eat something when we’re guests at someone’s house.

Not to say I won’t be secretly proud of her expansive vocabulary and undoubtedly witty repartee, of course.