Daily use of inhaled steroid may not be essential in mild asthma patients

By Lauretta Ihonor, medwireNews reporter

Individuals with mild-to-moderate asthma who use inhaled corticosteroids only when symptomatic can achieve the same level of symptom control as those who use the drug daily, study results show.

No significant difference in time to treatment failure was seen between asthmatic patients on either treatment regime, explain the authors.

"Our findings provide reassurance that symptom-based adjustment (SBA) of inhaled corticosteroid dose may be appropriate in most patients with mild-to-moderate asthma," say William Calhoun (University of Texas Medical Branch, Galveston, USA) and team.

However, they warn that "findings in well-controlled clinical trials may not translate directly to clinical practice."

The researchers analyzed the outcomes of 342 US adults with mild-to-moderate asthma who were treated with low-dose inhaled corticosteroids.

All patients (mean age 34 years) were randomly assigned to physician assessment-based adjustment (PABA; n=114), biomarker-based adjustment (BBA; n=115), or SBA (n=113) of inhaled corticosteroid therapy.

Patients allocated to PABA or BBA treatment received a specified dose of inhaled corticosteroids, which was adjusted every 6 weeks depending on the level of disease control reflected by biomarker or physician assessment results.

As reported in JAMA, 9-month Kaplan-Meier failure rate did not differ significantly between the groups, with respective rates of 22%, 20%, and 15% among PABA, BBA, and SBA patients.

Treatment failure was defined as asthma exacerbation, prebronchodilator morning peak expiratory flow (PEF) of less than 65% of baseline on two consecutive mornings, postbronchodilator PEF of less than 80% of baseline despite 60 minutes of rescue beta-agonist treatment, and/or worsening of in-clinic respiratory function measurements by 20% or more from baseline.

Assessment of specific patient outcomes, such as bronchial reactivity, lung function, and days missed from work or school revealed no significant intergroup differences.

"The current protocol of daily inhaled corticosteroid use is effective, but the flexibility and immediate probable cost savings for asthma medicine that a symptom-based approach may offer will appeal to many patients," concluded Calhoun.

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