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    Mild Asthma Patients May Do OK With Less Steroids

    Less Medication Used

    The nine-month study, sponsored by the National Heart, Lung, and Blood Institute, found that patients who inhaled a steroid only when they had asthma symptoms were no more likely to experience a worsening of their disease than those treated according to guidelines. In addition, the patients who inhaled a corticosteroid only when needed ended up using half as much drug as the others in the study.

    “This strategy empowers patients to take control of their asthma,” says William Calhoun, MD, a lung disease specialist at the University of Texas Medical Branch in Galveston and a researcher on the study.

    “We have some confidence that they will not do worse, and in some cases (they will) do better” than those who use inhaled corticosteroids twice a day, Calhoun says. A handful of other studies have also found the symptom-based approach to be effective, he says.

    In their editorial, though, O’Connor and Reibman write that larger studies are needed before the guidelines are changed to recommend that patients with mild to moderate disease use inhaled corticosteroids only when they have symptoms. Basing patients’ dose adjustments on exhaled nitric oxide levels hasn’t been shown to be effective, they write, so “there is no compelling rationale to alter the current approach to [inhaled corticosteroid] dosing.”

    For primary care doctors, following the guidelines and prescribing twice-daily use of inhaled corticosteroids “is [worthy], and it’s exactly the right thing to do,” Calhoun says. But, he says, he has offered some patients the symptom-based approach, which is probably best left up to asthma specialists.

    One concern is that patients with more serious asthma will try the symptom-based approach to inhaled corticosteroids, says Homer Boushey, MD, a longtime asthma researcher at the University of California, San Francisco, who worked on the study.

    “People underestimate the severity of their disease,” Boushey says, noting that lung function was carefully monitored in all of the patients in his study from beginning to end. “This is really only for people with truly mild disease” and under a doctor’s care.

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