Change in Asthma Treatment Proposed : Disease: Federal health officials say reducing inflammation of the airways is more important than easing constriction.

By MARLENE CIMONS

Feb. 6, 1991 12 AM PT

TIMES STAFF WRITER

WASHINGTON — In a move that could prompt a major change in the treatment of asthma, federal health officials urged physicians Tuesday to place greater emphasis on reducing or preventing inflammation of the body’s airways, rather than on trying to relieve bronchial constriction.

The National Heart, Lung and Blood Institute, releasing the first comprehensive guidelines for diagnosis and treatment of asthma, said traditional therapy has relied on symptomatic relief of constriction through the use of bronchodilator drugs that are inhaled.

These medications temporarily ease the wheezing, coughing, chest tightness and breathing difficulties that accompany an asthma attack by relaxing the bronchial muscles, thus opening the airways.

But an expert panel convened by the institute, part of the National Institutes of Health, said that for long-term control of the disease, it is more important to use anti-inflammatory agents to relieve swelling.

“We now know that inflammation is the predominant feature in asthma,” said Dr. Albert L. Sheffer, chairman of the panel and a clinical professor of medicine at Harvard University Medical School. “Reducing and hopefully preventing inflammation, not just reversing bronchial constriction, is central to asthma management.”

The report, written by an expert panel under the direction of the institute’s National Asthma Education Program, will be distributed to more than 150,000 health care professionals nationwide “as quickly as possible,” said Dr. Claude Lenfant, director of the institute.

“This report is very significant and even historic,” Lenfant said. “It represents the perspectives of allergists, pulmonologists, nurses and behavioral scientists. I believe it will have a profound impact on the way asthma is treated in this country.”

Asthma is a serious chronic disease that can be life-threatening. It afflicts nearly 10 million Americans, 3 million of them children. The death rate from asthma is almost three times higher among blacks than whites.

Experts have become worried because the number of new cases has been on the rise--increasing one-third between 1979 and 1987--and because deaths from the disease have increased steadily at a rate of about 6% a year. In 1988, about 4,580 Americans died from asthma.

“Why are the numbers for asthma apparently going in the wrong direction? The simple answer to that is that we do not know,” said Dr. A. Sonia Buist, head of pulmonary and critical care medicine for Oregon Health Sciences University.

Speculation has focused on possible increases in environmental substances that bring allergic responses or in the number of individuals with allergic sensitivities, “but this has not yet been confirmed,” she said.

Buist said it also is possible that the increase in asthma cases is attributable in part to more accurate diagnoses of the disease.

“We must also consider the possibility that people with asthma are not getting the right medicine for their condition, or they are not using it correctly,” she said. “Many patients and physicians may fail to appreciate the seriousness of an individual episode of asthma, the severity of the chronic disease or a deterioration in lung function.”

Sheffer said that bronchodilators, specifically, inhaled beta2- agonists, a class of asthma drugs, “are recommended to treat acute episodes because they provide rapid bronchodilation of the airways and relief of symptoms.”

However, he said, these drugs “do not appear to affect the underlying inflammation of the airways.”

The panel recommended the use of anti-inflammatory drugs, such as cromolyn sodium and inhaled corticosteroids, to reduce and prevent recurrence of inflammation.

Sheffer said many people have been concerned about possible adverse effects of corticosteroids because, traditionally, they have been administered orally.

But recent advances in asthma therapy have resulted in development of inhaled corticosteroids. “Their effect is directly on the airways, and they are not absorbed into the body’s circulatory system in the way oral corticosteroids are,” he said. “Thus, few adverse effects are encountered with inhaled corticosteroids, which are among the most effective agents used in asthma therapy.”

The panel emphasized that asthma is treatable.

“With appropriate treatment, virtually all asthma patients can become free of symptoms,” said Dr. Allan T. Luskin, associate professor of immunology at Rush Medical Center in Des Plaines, Ill. “Patients with asthma can live normal lives. They and their families should expect nothing less.”