The use of chromones (cromoglycates) in the treatment of asthma
- James P Kemp, MD
James P Kemp, MD
- Clinical Professor of Pediatrics
- University of California School of Medicine
The drugs, cromolyn sodium (or cromolyn) and nedocromil, are commonly grouped together as chromones (also called cromoglycates). The chromones are listed as alternate initial controller therapies for mild asthma in national and international guidelines, although inhaled glucocorticoids (also known as inhaled corticosteroids) are the preferred agents [1,2]. The low incidence of side effects compared with inhaled glucocorticoids is a leading reason some patients prefer chromones over inhaled glucocorticoids.
This topic will review the pharmacology and use of chromones in the management of asthma. A more general discussion of asthma therapy is found separately. (See "An overview of asthma management".)
LIMITATIONS ON AVAILABILITY
Cromolyn first became available in the 1970s. At present, availability of cromoglycates varies from one country to another, due in part to the need to change the propellants used in cromoglycate metered-dose inhalers (MDIs) [3,4]. The propellant originally had been a chlorofluorocarbon (CFC). Following adoption of the Montreal protocol (an international agreement to ban CFCs), inhalers that contain hydrofluoroalkane (HFA) were developed for some drugs. HFA formulations of cromolyn are available in the United Kingdom and a Spinhaler device is available in Australia, although neither of these is sold in the United States. (See "The use of inhaler devices in adults" and "The use of inhaler devices in children".)
In the United States, neither cromolyn nor nedocromil is available in HFA-containing MDIs, and no formulation of nedocromil is marketed for asthma. As a result, the only remaining formulations for asthma are solutions of cromolyn (10 mg/mL) for nebulization. However, dry-powder inhaler formulations for cromolyn and nedocromil are available in other countries (table 1).
The chromones have potent effects in preventing both early and late asthmatic responses to inhaled allergens, such as pollen, and reducing airway reactivity to a range of inhaled irritants, such as sulfur dioxide and cold air .
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- LIMITATIONS ON AVAILABILITY
- ROLE IN ASTHMA THERAPY
- Prevention of acute bronchoconstriction
- Efficacy as long-term maintenance therapy
- - Compared with inhaled glucocorticoids
- - Compared with other controller agents
- CLINICAL USE
- Choice of drug
- Initial dosing
- - Cromolyn
- - Nedocromil
- Adverse effects
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS