Asthma treatment according to English standards

Once I wrote an article “Asthma is treated by pharmaceutical companies ?” Well, what do doctors do? They write prescriptions according to their instructions. The article can be read here. I don’t know myself, but it turned out that the quote from “Woe from Wit” fit perfectly into the text. So think!

It is sad, but the countries where the incidence of asthma is the highest in the world (in the UK – up to 30% of the total population, in Germany – up to 20%, etc.) impose their scientific concepts and “standards” of asthma treatment in Russia. One would like to remember the notorious “Frenchman from Bordeaux” from Griboyedov ’s “Woe from Wit”, who teaches us about life. And exclaim with the words of the classic: “… so that the Lord destroys this unclean spirit of empty, slavish, blind imitation!”


leukotriene drugs for asthma


The American Lung Association has published the results of an independent study that denies previously published data that Montelukast , an antileukotriene drug for asthma, causes depression and increases the risk of suicide.

Comment: Antileukotriene drugs – acolate , singular and others in no way reduce the level of damage to the bronchial tree mucosa from the main inflammatory agent – histamine, which is a key mediator in the pathological mechanisms of asthma. But leukotrienes are not. But what is surprising is that often, on a “command from above”, doctors literally impose them on patients, but do not warn that antileukotriene drugs cause enough complications, which I wrote about in the book “Asthma. How to restore health. I will quote this text:

In recent decades, the search for alternative anti-asthma drugs has become an “obsessive” idea of many pharmacologists. In this regard, the main efforts were directed to the creation of drugs that affect pathological mechanisms involving leukotrienes .
As already mentioned, leukotrienes – metabolites of arachidonic acid – are of some importance in the development of the so-called aspirin asthma. In the process of biochemical reactions, various types of leukotrienes are formed. It is believed that the most important role in the implementation of the inflammatory mechanisms of asthma is played by cysteine , or sulfidopeptide , leukotrienes (hereinafter we will simply call them leukotrienes ). And so far, all the details explaining the participation and contribution of leukotrienes in the implementation of the inflammatory mechanisms of asthma have not been finally clarified . Leukotriene receptors themselves have not been sufficiently studied , and their role in the mechanisms of bronchial smooth muscle contraction, increased vascular permeability, etc. has not been elucidated. Nevertheless, more than 20 years ago, several dozen pharmaceutical companies joined the “race” to create anti- leukotriene anti-asthma drugs. The main efforts were directed to the creation of two groups of drugs: leukotriene synthesis inhibitors and substances that competitively bind leukotriene receptors (like antihistamines that bind the corresponding histamine receptors). As a result of these studies, hundreds (if not thousands) of compounds were synthesized, of which only four turned out to be active.
We are talking about the following pharmacological substances: zileuton , which affects the synthesis of leukotrienes , as well as protecting the corresponding receptors zafirlukaste , montelukast and pranlukaste . As soon as zafirlukast and montelukast under the trademarks ” Acolat ” and ” Singular ” appeared on the Russian pharmaceutical market, their extensive advertising campaign began.
If one of the readers has been following the press closely, he will agree that I am not exaggerating at all: there were flashes of reports about the Nobel Prize, and about the “new era” in the treatment of asthma, and that with these drugs all problems will be solved once and forever. Reports about these “miracle drugs” still appear in some newspapers, but passions have already subsided: not a single patient who took these drugs entered the “new era” of health, and, as it was immediately clear, their asthma did not disappear.
Well, when the results of the first wide clinical trials were summed up, it turned out that they look rather modest. In order not to be unfounded, I will give some figures. So, in patients taking zafirlukast , according to one study, the need for bronchodilator aerosols decreased by 17%, apparently, by one (!) inhalation dose. In other drugs, the need decreased by 19%, the researchers note. True, at the same time, the patient began to take one drug more! But science is silent about this. Here are excerpts from one scientific study ( Materia Medica “. Bulletin for doctors and pharmacists, 1998, No. 2 (18), Farmarus Print, Russian Medical Association.): “… zafirlukast ( Acolat ) is a fundamentally new drug for the basic therapy of BA (bronchial asthma) of Mild and moderate course… and can be combined with inhaled glucocorticoids and beta-2-agonists… Against the background of treatment with Acolat , there is a decrease in night and morning manifestations of BA .., the indices of respiratory function improve.” And then the dynamics of these indicators of respiratory function is given: before treatment, the air flow rate at the level of large, medium and small bronchi was 46, 34 and 26% of the norm, respectively. And after 6 months. after treatment, the figures are as follows: 46, 30 and 24%. The only indicator, the value of which “moved” from the dead point, was FEV1: for 6 months. treatment, it increased from 66 to 75% (data on statistical significance are not provided). To this it should be added that the measurement error of this indicator can be up to 10%. So the results of treatment of “patients with mild and moderate asthma” look rather modest (despite the fact that only 20 patients were examined). But what about severely ill asthmatics?
Generally speaking, a critical review of the published clinical trials of antileukotriene agents suggests that in many cases wishful thinking is presented as fact. And the situation as a whole looks a little strange: many claim their high efficiency and “complete control of asthma” (this is a quote from one of the messages on the Internet), but no one has objectively proven this. Most likely, antileukotriene drugs somehow improve subjective well-being without restoring any significant airway patency. But the price of this, both literally and figuratively, is too high. The price in medical terms is a high risk of side effects, and the price in economic terms is the discrepancy between the end result and the cost of these drugs.
And to make it clear, I will give excerpts from the annotation to one of the drugs – zafirlukast : “ Acolate is not indicated for stopping bronchospasm in acute asthmatic attacks. Accolate should not abruptly replace inhaled corticosteroid therapy. Perhaps … interaction with … aspirin, erythromycin, terfenadine , aminophylline. Care must be taken in deciding whether to reduce the dose of steroid hormones in patients with severe asthma, ”etc. The instructions even contain indications of the manifestation of “… early signs of hepatotoxicity ” when taking this drug and “an increase in the frequency of infections”, fortunately, “ usually mild”, but, unfortunately, “in elderly patients”.
It appears that many more years of sound scientific research is required to determine the place of antileukotriene agents in the treatment of asthma. It is most likely that antileukotriene agents will be useful in some patients with aspirin asthma, but no more. I will not develop this topic further, because, according to the data to date, it is too early to draw final conclusions.

And this is written not only in the book – just read the annotation to the drug. In addition, the result of their application is highly questionable. So, apparently, this study had one goal: to increase the level of sales.

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