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According to this article from the BBC, R-Roscovitine may be an alternative for asthmatics who are resistant to steroid treatments: http://news.bbc.co.uk/2/hi/uk_news/scotland/edinburgh_and_east/8403307.stm

The drug supposedly leads to reduced inflammation by reducing uncontrolled eosinophils, immune cells present in the found in the lungs and airways. Are these eosinophils a major contributor to most asthma cases? Is this really as revolutionary as the article makes it out to be?

This particulare drug is not itself an alternative to current standards of practice or guidelines. To quote the article;

"It could lead to an alternative way to treat asthma in patients who are resistant to steroid treatments".

Asthma is so much more complicated than being able to reduce eosinophils. Just to give you an idea,  here are some of the components involved in the airway response to an allergen:

Eosinophils, Neutrophils, Dendritic cells, Macrophages, Resident cells of the airway, Epithelial cells, Mast cells....These control and release all kinds of "Inflammatory Mediators".Not all asthma is greated equal.

R-Roscovitine has been around for some time, and there may be good research and development of new classes of drugs for the treatment of asthma being developed. However, this drug is no panacea.

James, great response. I didn't realize R-Roscovitine has been around for awhile already. I always think it's interesting when established drugs are found to have uses for different conditions.

It sounds like you're saying that this would only work for those who have asthma with increased eosinophils, which is potentially a small number of people? How would you even know if a person's asthma involves eosinophils?

Hi Angela and James

Yes, this is not a new approach.  Removing eosinophilis from asthmatics has been targeted for a very long time.   Early studies were negative, but it is now pretty clear that only about half of asthmatics actually HAVE excess eosinophils to get rid of.  Having said that, if you target those asthmatics WITH eosinophils, then there are TWO recent studies published in March in New England Journal of Medicine that suggested SPECIFICALLY targeting eosinophils with a biologic agent that blocked Interleukin-5 did improve some outcomes related to asthma in SEVERE asthmatics.    Primarily it allowed patients to be treated with lower doses of steroids (in a very small study) and to have a 40-50% decrease in asthma exacerbations.   However, there was no improvement in symptoms or lung function.   I, personally, believe that removing eosinophils will be helpful in maybe 5-10% of asthmatics who have both severe disease and increased eosinophils.   However, these specific eosinophil blockers are not likely to be BIG improvements in asthma therapy. 

Hi Dr. Wenzel,

Thank you for your insight. Wow, that's good to know that only half of asthmatics have excess eosinophils. Your explanation helps me understand how few asthmatics would potentially benefit from the new use of this drug. And it sounds like this wouldn't even apply to those without severe asthma. How can the level of eosinophils be tested in an asthmatic?

Hi Lisa,

Thank you for your response to the discussion. Because you are asking a question about your personal experiences It sounds like your post would be more appropriate as a question in our Questions & Answers section of Medpedia. You could also ask this as a question in the Asthma/COPD Community from the "Ask a Question about Asthma and COPD" link at the top of the page.

Thank you,

Angela

Angela

Finding out about eosinophils in asthmatics is not so easy.  The easiest thing is to look in the blood.  If there are more than 6% eosinophils there, it is likely they will ALSO be in the lung.  However, if there are NO eosinophils in the blood it does not tell you much about whether they will be there in the lung.  So, the BEST way to look is in what is call "induced  (or spontaneous) sputum".  This is done by having asthmatics breath in a salt water solution that makes them cough up phlegm. The phlegm is then looked at to see how many eosinophils are in the cells in the sputum.  It is mostly only done at centers which specialize in asthma.   Hope that helps.   

Dr. Wenzel,

Thank you, that does help. I thought the testing process might be difficult, and it's great to have you confirm that. It sounds like only patients with very advanced asthma would even find out if they were eligible for this treatment.

Thank you!