Daily Asthma Drugs Not Essential

Mild asthma may be controlled as effectively by short, intermittent courses of inhaled corticosteroids as by daily treatment, according to US research.

The study included 225 adults with persistent, mild asthma who did not smoke. Their FEV1 was at least 70 per cent of the predicted value and they responded to a methacholine 16mg challenge with a 20 per cent drop in FEV1.

The patients were assigned to take 200g of budesonide twice daily, 20mg of zafirlukast twice daily or a placebo inhaler.

All of the patients were told that if their asthma symptoms worsened they should take 800g budesonide twice daily for 10 days or 0.5mg of prednisolone per kilogram of body weight daily for five days.

After a year, there was no difference between the three groups in their improvement in morning peak expiratory flow.

They also found that patients taking the placebo inhaler did not have more exacerbations of asthma requiring additional therapy than patients taking daily treatment, and that their asthma-related quality of life improved at the same rate.

The researchers concluded that treating mild asthma with inhaled corticosteroids as needed was a viable approach.

Dr Hilary Pinnock, Kent GP and member of the General Practice Airways Group, said: ‘It’s what a lot of our patients do already, so it is good to see that intermittent treatment could be an effective approach.’

She added that GPs needed to ensure that patients who need regular treatment do receive it.

Dr David Price, professor of respiratory medicine at Aberdeen University, agreed: ‘Intermittent therapy is only appropriate for those who really have mild, intermittent disease.’

emma.baines@haynet.com

N Engl J Med 2005;352:1,519-28

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Copyright Haymarket Business Publications Ltd. Apr 15, 2005