The Pharmaceutical Journal
Vol 274 No 7345 p442
16 April 2005

This article
Reprint   Photocopy

  Acrobat Reader

News summary

Mild asthma may not require daily corticosteroid use

Intermittent courses of inhaled or oral corticosteroids could replace daily use of inhaled steroids for some asthma patients, results from a new study indicate.

Homer Boushey, of the University of California, San Francisco, and colleagues found that patients with mild persistent asthma who were treated with corticosteroids in response to symptoms had a similar rate of severe exacerbations as those treated daily. They also saw a similar rate of decline in asthma-related lung function.

The researchers assigned 255 adults to one of three treatment regimens — twice daily inhaled steroid (budesonide), twice daily oral leukotriene modifier (zafirlukast) or placebo. Patients also received a relevant matching placebo (tablets or inhaler) and were given instructions to use other asthma therapies (inhaled budesonide 800µg twice daily for 10 days or oral prednisone 0.5mg/kg daily for five days) if their symptoms worsened.

After one year the group treated with no controller therapy had neither poorer lung function nor a greater frequency of asthma exacerbations than those who received regular treatment. This was despite using rescue budesonide, on average, for only 0.5 weeks during the study. Patients who received corticosteroids each day did experience some benefits — more symptom-free days and less bronchial inflammation (New England Journal of Medicine 2005;352:1519).

In an accompanying editorial, Leonardo Fabbri, Modena University, Italy, comments that intermittent treatment with inhaled corticosteroids would be appealing for young patients with mild asthma. However, he warns that such treatment would not suppress the chronic airway inflammation or airway hyper-responsiveness associated with the disease and so more severe asthma may develop.

Anna Murphy, consultant respiratory pharmacist, Glenfield Hospital, Leicester, said: “As pharmacists, we are aware that patients are non-compliant with their inhaled corticosteroids and often start taking them when their symptoms deteriorate. Although this trial showed no significant difference between intermittent and regular inhaled steroids with respect to morning peak flow readings in patients with mild persistent asthma there was a difference in other measures of lung function and symptom-free days. favouring the regular conventional treatment.” She added that treatment of asthma should still be based on British guidelines, with use of the least amount of medication required to achieve control.