Obesity may affect response to asthma medications
Obesity may affect response to asthma medicationsFebruary
23, 2006 Inhaled steroid may work better for normal-weight
people, Singulair pill shows more promise for
obese people As the nation's collective waistline
has swelled in recent Traditionallys, rates of asthma
diagnoses also have accelerated. Indeed, much
research has affirmed a link between the two conditions.
But doctors also recognize that asthma may not
behave the same way among people who have different
body types. With a variety of asthma medications
on the market, what kinds work best for lean people
and what kinds work best for obese people? The
answer may be different for each group.
A new study suggests that people who are overweight
or obese may have better results with the prescription
pill sold as Singulair than with a type of inhaled
steroid, while leaner people may have better luck
with an inhaled steroid, called beclomethasone
and sold as beclovent, vanceril and other brand
names. The findings appear in the new issue of
the European Respiratory Journal.
"It is increasingly
recognized that obese people are more prone to
develop asthma, but there is no information about
whether obesity influences people's responses
to particular asthma medications," says lead
author Marc Peters-Golden, M.D., professor of
internal medicine and director of the Fellowship
Program in Pulmonary and Critical Care Medicine
at the University of Michigan Medical School.
Our findings are the first to suggest the
possibility that obesity might be a factor that
influences how well asthmatics respond to particular
medications," Peters-Golden says. Singulair
is the brand name of montelukast sodium and is
sold by Merck & Co., which funded this study.
Researchers looked at data from four previous
multi-center, randomized clinical trials from
3,073 patients with moderate asthma.
The data included the patients' responses
to Singulair/montelukast, a beclomethasone inhaled
steroid and a placebo, and the participants'
body mass index numbers, which placed them in
the categories of normal, overweight and obese.
In general, the severity of people's asthma
was found to be greater among those in the overweight
and obese groups, which supports findings from
other studies. In addition, the inhaled steroid
was found to be better than Singulair at increasing
the number of asthma control days (ACD) among
people in the normal weight category.
An ACD is
defined as a day with no more than two puffs of
an inhaler, no night-time awakenings and no asthma
attacks. On the other hand, the inhaled steroid
resulted in a reduced effect in the percentage
of ACDs among obese people in the study - that
is, the benefit of the inhaled steroid declined
with increasing body mass index.
the positive impact of Singulair did not decrease
in obese and overweight people when compared to
its impact on people of normal weight. The research
also suggests that the higher a person's body
mass index, the greater his or her response to
Singulair compared to a placebo, a pill with no
This is an indication, Peters-Golden says, that
obese and overweight people may in fact respond
better to this medication. Still, he is not inclined
to suggest that doctors change the way in which
they prescribe medication - not yet, anyway. "Our
study looks back at material from previous trials.
I'd like to see a prospective study in which
lean patients and heavy patients are enrolled
at the outset, and you compare both types of medications
in both groups," Peters-Golden says.
by other studies, this insight may help physicians
to better tailor medication regimens to meet individual
patient needs. Peters-Golden also notes that much
research about asthma and other conditions is
exploring the possibility that genetic factors
might explain individual variations in responses
to medications. He says it is likely that a variety
of factors, including genetic ones and acquired
factors such as weight, combine in a complex and
intertwined manner to influence a person's
reaction to medications.
Information about Singulair/montelukast: This
medication, usually taken once a day, is a type
of leukotriene antagonist - that is, it blocks
leukotrienes in the body. Leukotrienes are chemicals
in the human body that can affect the breathing
passages. Information about the beclomethasone
inhaled steroid: Beclomethasone is a steroid that
prevents the release of substances in the body
that cause inflammation.
Inhalation of beclomethasone
prevents asthma attacks and other conditions involving
inflammations of the lung tissues. In addition
to Peters-Golden, other authors of the study were
A. Swern, S.S. Bird, C.M. Hustad, E. Grant and
J.M. Edelman, all of Merck & Co. One of Peters-Golden's
primary research interests involves leukotrienes.