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A Possible Change in Asthma Management

Posted on: Wednesday, 13 April 2005, 15:00 CDT

Contrary to current guidelines and practice, many people with mild chronic asthma need to inhale anti-inflammatory steroids only after experiencing an attack rather than every day, a new study indicates.

The yearlong controlled study, published Thursday in The New England Journal of Medicine, showed that adult sufferers had about the same number of severe attacks, frequency of symptoms and quality of lung function whether or not they took a steroid drug every day or only during attacks.

"This study will need confirmation before we change the standard of practice, but it suggests that adults with mild asthma may do about as well if they have the medications on hand and are advised to take them for a week or two just when their symptoms flare up," said Dr. Homer Boushey, a professor of medicine at the University of California-San Francisco and co-leader of the Improving Asthma Control Trial.

About 20 million Americans suffer from asthma, with most experiencing symptoms that are mild and either intermittent or persistent. Intermittent asthma is characterized by infrequent wheezing, chest tightness or difficulty in breathing. Persistent asthma is defined as having such symptoms more than once a week, but not daily, or nighttime awakening due to asthma more than two nights a month.

Since 1997, experts at the National Heart, Lung and Blood Institute have recommended the daily use of inhaled steroids or other daily "controller" medication to prevent attacks and counter the possibility of permanent airway scarring that would make breathing even more difficult.

But only about 30 percent of patients who are prescribed inhaled steroids for preventive use refill prescriptions.

"Either because patients experience no obvious, immediate benefit, or because they are concerned about using inhaled steroids, most people discontinue steroid use for asthma," Boushey said. "Our study shows that for mild asthma, at least for the short term, this 'folk wisdom' is a safe practice."

Institute guidelines are to be updated next year after an expert panel considers this and other asthma studies.

According to the researchers, if all of the estimated 4 million Americans with mild persistent asthma took inhaled steroids only when symptoms flared, medication costs would be about $2 billion less a year.

However, the study's authors stressed that those taking daily medications now should not stop on their own.

"Choosing not to take daily medications may be OK, but this choice should be made in consultation with the patient's health-care provider," said Dr. Elliot Israel, co-leader of the study. Israel is affiliated with Boston's Brigham and Women's Hospital and Harvard Medical School.

"People with more severe asthma must follow recommendations for daily medications and all asthma patients _ even those with mild asthma _ should adequately treat their symptoms," Israel added.

"Symptom-based treatment might work for patients who understand their symptoms, keep track of them and are willing to be checked on a regular basis to make sure their lung function is not deteriorating," agreed Dr. Jonathan Field, director of the Allergy and Asthma Clinic at New York University.

The six-city study involved 225 patients with mild persistent asthma. Participants took daily doses of one of two types of preventive anti-inflammatory drugs (corticosteroids or anti-leukotrienes) or a placebo. All were given clearly labeled inhaled steroid sprays to take for short periods of mild worsening of asthma, and prednisone tablets for more severe episodes.

All those enrolled were taught how to recognize symptoms of worsening asthma and how to treat themselves with short courses of therapy. Many patients reported that simply learning how to take care of themselves made a difference in their ability to live with asthma even after the study ended.

After a year, all three groups not only had similar lung function and severity of symptoms, but also reported similar scores on measures of physical, social and emotional impacts of asthma.

On the Net: www.nejm.org

www.nhlbi.nih.gov

(Contact Lee Bowman at BowmanL(at)SHNS.com. Distributed by Scripps Howard News Service, http://www.shns.com)

© 2004 Scripps Howard News Service.

All Rights Reserved.

Source: Scripps Howard

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