New Options for Mild Asthma Treatment

Using Inhaler as Needed May Replace Twice-Daily Treatments

Medically Reviewed by Brunilda Nazario, MD on May 16, 2007
From the WebMD Archives

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 suggest.

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 rate.

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 release.

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 doctor's advice.

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SOURCES: Papi, A. The New England Journal of Medicine, May 17, 2007; vol 356: pp 2040-2052. Peters, S.P. The New England Journal of Medicine, May 17, 2007; vol 356: pp 2027-2039. Norman H. Edelman, MD, scientific consultant, American Lung Association; vice president, Health Science Center and dean, SUNY-Stony Brook School of Medicine, New York. News release, Wake Forest University Baptist Medical Center.

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