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Mild Asthma Patients May Do OK With Less Steroids

By Rita Rubin
WebMD Health News
Reviewed by Louise Chang, MD

Sept. 11, 2012 -- People with mild to moderate asthma might fare just as well inhaling steroid medications only when they have symptoms instead of twice every day as recommended, researchers report.

Basing treatment on symptoms could reduce the amount of drug used, minimize the risk of side effects, and may save billions of dollars in health care costs every year, researchers say.

Guidelines advise that people with mild to moderate asthma use inhaled corticosteroids twice a day to control their asthma. In addition, patients are supposed to use fast-acting “rescue” medications, such as albuterol, when needed to open up their airways and relieve symptoms.

Under the guidelines, “I think we’ve managed a lot of patients very well,” says Norman Edelman, MD, chief medical officer of the American Lung Association. He was not involved in the study.

But getting people to use inhaled corticosteroids every day when they feel fine “is a huge issue,” Edelman says. “Patients tend to take medicine until they feel as good as they’re going to feel.”

The study appears in this week’s Journal of the American Medical Association.

Birth of an Idea

Patients’ frequent skipping of inhaled corticosteroids led to the idea that tying the drugs’ use to that of the rescue medications might lead to better asthma control for those with relatively mild disease, George O’Connor, MD, and Joan Reibman, MD, write in an editorial accompanying the study.

To test that, researchers assigned 342 adults to one of three treatment groups. All of the study participants had mild to moderate asthma that was controlled by inhaled steroids.

For one group, a doctor following National Asthma Education and Prevention Program guidelines prescribed twice-daily inhaled steroids, adjusting the dose if deemed necessary at visits every six weeks.

In the second group, doctors adjusted patients’ twice-daily dose of steroids based on a check every six weeks of how much nitric oxide they exhaled. When airways are inflamed, the lungs produce higher levels of nitric oxide, so measuring how much of the gas is exhaled is used to help monitor the effectiveness of asthma medications.

In the third group, patients took two puffs of a steroid every time they took two puffs of albuterol to relieve asthma symptoms.

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.

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