For Release: April 9, 1999
Contact: Kimberly Lynch, ACCP
(847) 498-8341
NATIONWIDE SURVEY SHOWS ANTI-INFLAMMATORY AGENTS ARE UNDER USED IN CYSTIC FIBROSIS
A nationwide survey of 67 cystic fibrosis (CF) centers shows that anti-inflammatory medications are underutilized by physicians when treating children and adults with CF in the U.S., according to an article published in the April issue of CHEST.
In addition, when physicians do order an anti-inflammatory medication, they twice as often prescribe the one for which there are the fewest clinical safety studies.
Writing in the peer-reviewed journal of the American College of Chest Physicians (ACCP), Christopher M. Oermann, M.D., of the Department of Pediatrics, Baylor College of Medicine, Houston, Texas, together with two associates, pointed out that approximately 25 percent of 8,803 CF patients in the survey routinely used anti-inflammatory drugs. Only 41 to 45 percent of the 70 CF practitioners in the survey prescribed specific anti-inflammatory agents, and when they did prescribe, they tended to order inhaled corticosteroids at twice the rate of either oral corticosteroids or ibuprofen.
Cystic fibrosis, a genetic disease, causes the body's major glands such as the pancreas, lungs, and intestines to become clogged with thick mucus. Also, sufferers have difficulty in absorbing fats and other nutrients from food. Among its youthful victims, respiratory infections are common and can lead to death. However, life expectancy has improved dramatically in recent years due to better treatment, and many sufferers now reach adulthood.
In studies with CF patients, anti-inflammatory medications, including oral corticosteroids and ibuprofen, have been shown to be effective in reducing chronic inflammation connected with ongoing infection which plays a dominant role in CF lung disease. According to the authors of the survey, short-term trials of the anti-inflammatory agent, inhaled corticosteroids, have produced inconclusive results. In discussing another drug which was shown to be an effective anti-inflammatory, the authors note that the oral corticosteroid prednisone, at higher doses, caused adverse side effects in some subjects in the long-term studies described in the article. These problems included growth retardation, glucose intolerance, cataracts, and pathologic fractures.
However, survey results showed that inhaled corticosteroids, whose few studies have yielded conflicting results, were the most commonly prescribed anti-inflammatory agent. They were being used by 12 percent of the patients, about twice the usage rate of oral corticosteroids or ibuprofen.
Although inhaled corticosteroids were the least studied and most prescribed, the authors believe the reason physicians order the drug is their belief in its efficacy and safety in treating asthma.
"In contrast to the greater use of inhaled corticosteroids in CF patients," said Dr. Oermann, "we found that lack of efficacy data was the most common reason given by physicians not to prescribe the drug for routine control of CF lung disease."
Dr. Oermann continued: "The limited use of oral corticosteroids is likely due to concerns over adverse effects and long-term safety also. However, one must question whether these risks outweigh the benefits of improved lung function for selected patients in a fatal disease whose primary cause of death is respiratory failure."
The article comments on the lack of use of anti-inflammatory agents in patients under age 5. It points out that the clinical trials for oral corticosteroids and ibuprofen did not include subjects under 5 years because of an inability to perform pulmonary function testing on these patients. Consequently, the resulting treatment guidelines did not incorporate younger patients.
The authors wrote: "However, it is clear that excessive inflammation occurs early in life, well before the age of 5 years in most patients. Therefore, it is these patients who are likely to benefit most from anti-inflammatory therapy, and it has been suggested that this therapy needs to begin much earlier than 5 years." The paper stresses that future research efforts should focus on these younger patients.
CHEST is published by the American College of Chest Physicians, which represents 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the U.S. and throughout the world.
Reporters may wish to contact Kimberly Lynch of the ACCP at (847) 498-8341 for a full copy of the article. She can also be reached by fax at (847) 498-5460. The table of contents and the abstracts of all articles appearing in the April issue of CHEST are available on the ACCP Web site at Dr. Oermann of the Baylor College of Medicine can be reached by phone at (713) 770-3300.
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