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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Concept to Clinic: Current and Developmental Advances in Asthma Therapy


GOAL
To provide residents and fellows in pulmonary, allergy, and internal medicine with current, clinical information on new developmental advances in asthma therapy.

TARGET AUDIENCE
This activity is designed for residents and fellows in pulmonary, allergy, and internal medicine.

LEARNING OBJECTIVES
After reading this issue, the participant should be able to:

  • Explain the scientific, clinical, and economic rationale for using combination therapy for treating patients with asthma.
  • Identify the type of patient with asthma who would benefit from using combination therapy.
  • Describe the new strategies for asthma treatment, such as anti-IgE, anticytokine, and DNA therapies.

SPONSORSHIP STATEMENT
This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this activity.

This program was produced under the supervision of Peter S. Creticos, MD, Associate Professor of Medicine, Clinical Director, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine.

This program is supported by an unrestricted educational grant from GlaxoSmithKline.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

FACULTY ADVISOR

    Peter S. Creticos, MD
    Associate Professor of Medicine
    Clinical Director, Division of Allergy and Clinical Immunology
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Creticos reports serving on the speakers' bureau for, as a consultant to, and receiving grant/research support from Allergenics, Aradigm, Aventis, AstraZeneca, Dynavax, GlaxoSmithKline, Merck, Muro, Pfizer, Pilot Therapeutics, Schering-Plough, and Stallergenes.

PARTICIPATING FACULTY

    Bruce S. Bochner, MD
    Professor of Medicine
    Johns Hopkins Asthma & Allergy Center
    Baltimore, Maryland
    • Dr Bochner reports serving on the speakers' bureau for and as a consultant to Aventis and Merck; having scientific collaboration with Icos, GlaxoSmithKline, and Human Genome Sciences; receiving grant support from Pfizer; and serving as a consultant to Dupont Pharma and GlaxoSmithKline.

    Jonathan Corren, MD
    Associate Clinical Professor of Medicine
    University of California, Los Angeles
    Director, UCLA Nasal and Sinus Disease Center
    Los Angeles, California
    • Dr Corren reports receiving research support from Schering-Plough, GlaxoSmithKline, Novartis, Immunex, Protein Design Labs, and Millennium.

    James Donohue, MD
    Professor of Medicine
    University of North Carolina at Chapel Hill
    School of Medicine, Pulmonary Division
    Chapel Hill, North Carolina
    • Dr Donohue reports serving on the speakers' bureau for, as a consultant to, and receiving other support from GlaxoSmithKline and Boehringer Ingelheim; serving on the speakers' bureau for Pfizer and AstraZeneca; and receiving other support from Aventis.

    Richard J. Martin, MD
    Professor of Medicine
    University of Colorado Health Sciences Center
    Head of the Pulmonary Division
    Vice Chair of the Department of Medicine
    National Jewish Medical and Research Center
    Denver, Colorado
    • Dr Martin reports serving on the speakers' bureau for, as a consultant to, and receiving research support from GlaxoSmithKline, Schering-Plough, Novartis, 3M, Merck, Forest Labs, AstraZeneca, Boehringer Ingelheim, Purdue, and Aventis; and consulting for Genetec.

    Harold S. Nelson, MD
    Professor of Medicine
    University of Colorado Health Sciences Center
    Senior Faculty Member
    National Jewish Medical and Research Center
    Denver, Colorado
    • Dr Nelson reports serving on the speakers' bureau for, as a consultant to, and receiving grant support from GlaxoSmithKline, AstraZeneca, and Novartis; receiving grants from and/or consulting for Schering-Plough, Forest Labs, Aventis, Dura, Dex, Immunex, Protein Design Labs, and Millennium.

    Richard D. O'Connor, MD
    Clinical Professor of Pediatrics
    University of California, San Diego
    Director of Quality Management
    Sharp Rees-Stealy Medical Group
    San Diego, California
    • Dr O'Connor reports no financial or advisory relationships with any additional corporate organizations.

    David Stempel, MD
    Clinical Associate Professor
    University of Washington
    Medical Director of Health Outcomes
    Virginia Mason Medical Center
    Seattle, Washington
    • Dr Stempel reports serving on the speakers' bureau for and as a consultant to GlaxoSmithKline.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Concept to Clinic: Current and Developmental Advances in Asthma Therapy
Proceedings from the First Annual Resident and Fellow Asthma Summit
Peter S. Creticos, MD*

Over the past decade, increased understanding of the pathophysiology of asthma has resulted in significant advances in asthma pharmacotherapy, specifically, new ways of using established therapies and novel agents directed at newly discovered pathophysiologic targets. To hear about the most recent developments in asthma pharmacotherapy, pulmonary residents and fellows from medical schools across the United States participated in the First Annual Resident and Fellow Asthma Summit meeting held on May 17-18, 2001, in San Francisco, California, proceeding the annual American Thoracic Society congress. The Asthma Summit program comprised 8 presentations given by leading experts on the topics of asthma pathophysiology, current therapeutic approaches to asthma, and developmental asthma therapies. This issue of Advanced Studies in Medicine summarizes the proceedings of the Asthma Summit program.

The Asthma Summit program comprised 3 segments-the first on epidemiology and pathophysiology of asthma; the second on the scientific, clinical, and economic rationales for combination therapy in asthma; and the third on developmental pharmacotherapies for asthma. During the first session of the symposium, Dr Richard D. O'Connor described new data from the 1998 Asthma in America study, a population-based survey representing all regions of the United States and one of the most comprehensive national studies to be conducted on asthma. The survey reveals that 6.7% of the US population currently suffers from asthma. For a substantial number of these patients with asthma, poor control of symptoms and lung function causes significant impairment of normal daily functioning and decrements in quality of life. Patients are acutely aware of the impact of asthma on their daily functioning, but they overestimate the degree of control they have over their symptoms. Moreover, many patients are unaware of the pathophysiologic basis of their disease and of the fact that asthma pharmacotherapy is not merely palliative, but can control the disease process itself. Dr O'Connor concluded that these data underscore the need to educate patients about the physiologic basis of asthma, the clinical significance of asthma symptoms, and the high level of functioning possible with currently available therapy.

To conclude the first session of the symposium on asthma epidemiology and pathophysiology, Dr Richard J. Martin described the newest findings in airway remodeling. Traditionally viewed as a completely reversible disorder, asthma is now recognized as having an irreversible component that is probably caused by structural changes constituting airway remodeling. Concepts of airway remodeling and strategies for controlling or preventing it continue to evolve. Dr Martin presented encouraging data suggesting that aspects of airway remodeling appear to be amenable to treatment with currently available therapies.

The second session of the symposium was devoted to establishing the scientific, clinical, and economic rationales for combination therapy involving use of a long-acting b2 agonist with an inhaled corticosteroid for patients not adequately controlled on inhaled corticosteroid therapy alone. Drs James Donohue and Harold S. Nelson discussed the scientific and clinical rationales, respectively, for combination therapy. Both mechanistically and clinically, the long-acting b2 agonist salmeterol demonstrates complementary and often synergistic effects with those of corticosteroids. Regardless of whether clinical symptoms or anti-inflammatory mechanisms are the subject of study, (1) the addition of salmeterol potentiates corticosteroid effects in applications responsive to corticosteroids; and (2) the combination of salmeterol and a corticosteroid often has greater activity than either component alone in applications responsive to both corticosteroids and long-acting b2 agonists. The combined use of salmeterol and corticosteroids thus expands the treatment options for patients with asthma and provides the clinician with additional means of optimizing therapy for respiratory diseases to meet patients' individual needs. To close the second session of the program, Dr David Stempel presented data showing that combination therapy involving a long-acting b2 agonist and inhaled corticosteroids also conserves health care resources compared with several other therapeutic options in asthma.

During the final session of the symposium, developmental asthma therapies with novel mechanisms of action were discussed. Dr Jonathan Corren presented exciting data on a new anti-immunoglobulin E (IgE) monoclonal antibody that nearly eliminates IgE, a trigger of the allergic cascade, from the bloodstream. Because the monoclonal antibody has the potential to control multiple allergic diseases in a single patient, it may prove one day to be particularly useful for the 80% of patients who suffer from both asthma and allergic rhinitis. Data on several new anticytokine and antichemokine compounds were reviewed by Dr Bruce S. Bochner. While the therapeutic utility of many of the new anticytokine and antichemokine agents remains to be established, the data are encouraging. Finally, symposium chairman Dr Peter S. Creticos described data with a novel immunostimulatory oligonucleotide conjugate, which appears on the basis of research conducted to date to have low allergenicity and high immunogenicity-desired attributes for a potential antiasthma immunotherapy. Within the next few years, the armamentarium for asthma and other allergic diseases may well have expanded to include some of these novel therapies.

The presentations generated lively discussion and were well received by the residents and fellows. Participants in the Asthma Summit came away from the program with a solid understanding of the most recent developments in asthma. They expressed excitement about both the information on combination therapy-with immediate practical relevance because it can be implemented with currently available treatments-and the data on developmental therapies that may become available for clinical use in the future.

*Associate Professor of Medicine, Clinical Director, Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.