New Options for Mild Asthma Treatment
Using Inhaler as Needed May Replace Twice-Daily Treatments
May 16, 2007 -- Twice-daily whiffs of steroid drugs may become a thing of
the past for people with mild but persistent asthma, two new studies
Once a person gets mild asthma under control, current treatment guidelines
suggest keeping it under control with two daily doses of a steroid inhaler.
While the inhalers are safe in the short term, there's worry about the
long-term side effects of daily steroid treatments. And many patients simply
forget to take their medication properly.
Now a 500-patient study from the American Lung Association shows that
once-daily treatment with an inhaler that combines a steroid with a long-acting
bronchodilator (Advair) works as well as using a steroid inhaler (Flovent)
twice a day in patients with asthma that is well controlled.
Patients on either treatment had a 20% chance of treatment failure -- that
is, an asthma attack requiring urgent medical attention.
The study also found that these treatments work better than Singulair, a new
kind of allergy drug taken once a day in pill form, which had a 30% failure
Singulair worked very well for many patients, but it doesn't work as well as
steroid inhalers alone or in combination with a long-acting bronchodilator,
says Norman H. Edelman, MD, scientific consultant to the American Lung
Association and dean of the SUNY-Stony Brook School of Medicine, New York.
"This is good news for patients with mild, persistent asthma because it
gives them more choices about how to manage their disease," study
researcher Stephen E. Peters, MD, PhD, professor of pediatric and pulmonary
medicine at North Carolina's Wake Forest University, says in a news
Even better news comes from an Italian study showing that patients with mild
asthma can keep their disease under control without any daily medication at
all. The study shows that using an inhaler combining a steroid and a
short-acting bronchodilator only when the need arises works as well as using a
steroid inhaler twice a day.
"Mild, persistent asthma may not require regular treatment with inhaled
corticosteroids, but rather only as-needed use of an inhaled corticosteroid and
an inhaled bronchodilator, although the dose of [steroid] used in our study was
relatively high," suggest Alberto Papi, MD, of the University of Ferrara,
Italy, and colleagues.
The new inhaler is made by Chiesi Pharmaceuticals, Parma, Italy, which
funded the study.
Current asthma treatment guidelines stress scaling up medication until
asthma attacks are under control. But the real problem for most patients is
scaling down their asthma treatment to the minimum level needed to maintain
control, Edelman says.
"What these two papers are doing is looking at the question, 'What is
the minimum therapy needed to give good asthma control?" Edelman tells
WebMD. "This now gives the doctor an option. With once-a-day combination
treatment, you get better patient compliance -- and it costs less. Cost is an
issue, because these inhalers are expensive."
Of course, no one should change his or her asthma treatment without a