Revaluating Daily Therapy for Mild Asthma

April 7, 2006

Internists at the American College of Physicians Annual Session reviewed the implications of a recently published study [Boushey HA, et al. N Engl J Med 2005;352:1519-28] that's generated significant debate on the role of daily treatment with inhaled corticosteroids in the management of adults with mild asthma. Robert E. Reisman, MD, clinical professor of medicine and pediatrics, State University of New York, Buffalo, discussed the double-blind study that randomized 225 patients with longstanding, mild, persistent asthma into three treatment groups.

Internists at the American College of Physicians Annual Session reviewed the implications of a recently published study [Boushey HA, et al. N Engl J Med 2005;352:1519-28] that's generated significant debate on the role of daily treatment with inhaled corticosteroids in the management of adults with mild asthma. Robert E. Reisman, MD, clinical professor of medicine and pediatrics, State University of New York, Buffalo, discussed the double-blind study that randomized 225 patients with longstanding, mild, persistent asthma into three treatment groups.

The groups received intermittent, short-course corticosteroid treatment guided by a symptom-based action plan alone or in addition to ongoing treatment with the inhaled corticosteroid budesonide (Pulmicort) or the oral leukotriene receptor antagonist zafirlukast (Accolate).

After one year, there were no significant differences between the three groups with respect to increases in morning peak expiratory flow, asthma exacerbation rates, or quality of life. Based on their findings, the authors suggested that as-needed use of intermittent courses of inhaled or oral corticosteroids might be a viable method for treating mild persistent asthma, but should be further studied.

However, additional assessments in the study showed daily corticosteroid treatment had significant benefits compared to the other groups with respect to improving bronchial reactivity, percentage of eosinophils in sputum, and exhaled nitric oxide, endpoints that are markers of airway inflammation.

"Existing guidelines for asthma management were last updated in 2002 and recommended daily therapy for patients with mild persistent asthma. Eliminating the use of inhaled steroids would certainly reduce the substantial cost of treating asthma, but the fundamental question that remains unanswered is whether continuing with an inhaled steroid might have value over the longer term for preventing chronic airway changes," Reisman concluded.