![]() ![]() Reducing asthma symptoms and future risk through correct add-on therapy and management in patients who remain uncontrolled despite treatment is a major challenge for those working in both secondary and primary care. Physicians may underestimate the prevalence and severity of symptoms and overestimate the degree to which the patient’s asthma is controlled, meaning the patient may not receive adequate medication to achieve control of their disease 2, 7. It has been suggested that patients may overestimate and thus inaccurately report their level of disease control, because they accept and tolerate a certain level of symptoms, assuming them to be an inevitable consequence of asthma 7, 8. Many patients with asthma remain symptomatic, despite treatment, for multiple different reasons 2, 3, 4, 5, 6. This information could aid decision-making in primary care, supporting the use of add-on therapy to ICS to help improve lung function, control asthma symptoms and prevent exacerbations.Īsthma is a serious global health issue that affects all age groups, with a reported 339 million sufferers worldwide, presenting a number of challenges for primary care physicians 1. In children, results were positive and comparable between therapies, but data are scarce. In adults, LAMAs and LABAs provide a greater improvement in lung function than LTRAs as add-on to ICS. We explore the challenges of asthma management in primary care and review outcomes from randomised controlled trials and meta-analyses comparing the long-acting muscarinic antagonist (LAMA) tiotropium with long-acting β 2-agonists (LABAs) or leukotriene receptor antagonists (LTRAs) as add-on to ICS in patients with asthma. However, many patients remain poorly controlled, and evidence-based algorithms to decide on the best order and rationale for add-on therapies are lacking. Sunovion expects glycopyrrolate to be available in U.S.The Global Initiative for Asthma recommends a stepwise approach to adjust asthma treatment to the needs of individual patients inhaled corticosteroids (ICS) remain the core pharmacological treatment. Glycopyrrolate was well tolerated, and the overall treatment emergence of adverse events for glycopyrrolate and tiotropium bromide were similar. It also compared treatment of COPD with glycopyrrolate to treatment of COPD with the previously approved LAMA Spiriva (tiotropium bromide), delivered by the Handihaler device. GOLDEN-5, an additional study, followed the same criteria as previous studies, but increased its length to 48 weeks to evaluate the long-term safety and patient tolerability of glycopyrrolate. At 12 weeks, patients receiving treatment with glycopyrrolate showed clinical and statistically significant improvements in their baseline forced expiratory volume second (FEV 1), compared with placebo. The GOLDEN program comprised the GOLDEN-3 and GOLDEN-4 trials, both of which were phase 3, 12-week, randomized, double-blind, placebo-controlled, parallel-group, multicenter safety and efficacy trials, which compared adult glycopyrrolate patients to a placebo group with moderate to severe COPD. The approval of glycopyrrolate is based on the results of the GOLDEN (Glycopyrrolate for Obstructive Lung Disease via Electronic Nebulizer) trials. “Lonhala Magnair offers an important new option that combines the efficacy of a proven medication for COPD with the attributes of a unique, handheld nebulizer that allows a person to breathe normally while taking their medication.” “Despite the availability of several therapies, many people still struggle to control their COPD – a challenge that may be affected by the delivery method used to administer a medication,” Gary Ferguson, MD, of Michigan State University and the Pulmonary Research Institute of Southeast Michigan, both in Farmington Hills, said in a statement.
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