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Daily Drugs Not Always Needed for Mild Asthma

Study Shows That Patients Fare Just as Well With Symptom-Driven Therapy
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WebMD Health News

April 13, 2005 -- Many adults with mild persistent asthma may not need daily inhaled steroid treatments to adequately control the condition, according to findings from a new government study.

The surprising results could lead to a change in treatment guidelines for asthma, which currently call for daily therapy with inhaled steroids even in those that do not have daily symptoms.

Each person is different and no one should make a change to their asthma treatment without first talking to their doctor.

Studies have supported the current guidelines. Researchers have shown that daily treatment with inhaled steroids leads to the control of asthma and may stabilize the disease and prevent its progression. But the newly reported Improving Asthma Control Trial (IMPACT) found that this daily treatment approach was no better than treating only when asthma symptoms occur in adults with mild persistent asthma.

The findings are published in the April 14 issue of The New England Journal of Medicine.

Still Some Questions About Treatment

"Using these drugs in an intermittent fashion [to control symptoms] rather than on a regular basis does seem to be an appropriate option for many asthma patients," James Kiley, PhD, tells WebMD. Kiley is director of the National Heart, Lung, and Blood Institute's division of lung diseases, which oversaw the study.

But Kiley also offered several large caveats to the findings. Most study participants had asthma for a long time. It's not clear that, if there is a treatment advantage to daily inhaled steroids, whether this translates to treatment for newly diagnosed patients with mild, but chronic, asthma.

And it is also not clear if children with mild asthma benefit from daily treatment. Similar studies are now under way in children to address this question.

Persistent asthma is generally considered mild when symptoms such as wheezing, coughing, or chest tightness occur more than twice a week, but not daily, or when patients awaken during the night due to symptoms more than two nights a month.

While daily inhaled steroids have been recommended for mild asthma for more than a decade, there is a good deal of evidence that patients aren't following this advice.

Kiley says prescription reviews and patient surveys indicate that people with mild asthma often use inhaled steroids only when bothered by symptoms. The newly published study was designed to determine whether this approach resulted in poorer asthma control.

Little Difference Among Treatment Groups

Researchers compared changes in tests of lung function, frequency and severity of asthma symptoms, and quality-of-life variables in 255 adult patients with mild symptoms assigned to one of two daily treatment regimens or to treatment only when symptoms occur.

Participants received one of the following treatments: Oral asthma medication and an inhaled placebo; inhaled asthma medication and an oral placebo; or both oral and inhaled placebos.

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