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Daily treatment may be unnecessary for mild asthma patients

SAN FRANCISCO, CALIFORNIA. Millions of people take asthma medication regularly to alleviate their wheezing, coughing, and chest tightness. Standard treatment usually comprises two drugs: a bronchodilator medication for immediate relief through the stimulation of beta-receptors in the autonomic nervous system, and daily use of inhaled corticosteroids to reduce airway inflammation and minimize risk of severe asthma attacks and airway scarring that might permanently reduce lung capacity.

Now researchers from the University of California, San Francisco have questioned the recommendation for daily therapy, especially as many patients use it irregularly. They monitored 225 adults with mild persistent asthma for a year. The patients were all instructed to take medication for several days when they felt symptoms come on. They were then randomized to twice daily treatment with either a budesonide inhaler (a corticosteroid known as Pulmicort) and placebo pills, or zafirlukast pills (an anti-leukotriene known as Zyflo or Singulair) and a placebo inhaler, or placebo pills and a placebo inhaler. At the end of the study, there was no significant difference between the groups regarding peak expiratory flow (PEF), which measures how well a person can expel air from their lungs. Average PEF increased by eight per cent in each group. Comparable rates of asthma exacerbations were also found. Daily budesonide led to a greater number of symptom-free days and less bronchial inflammation, but did not significantly reduce the risk of severe attacks or prevent loss of pulmonary function. Daily zafirlukast showed no benefit over medication taken only in response to symptoms.

The researchers conclude that short, intermittent courses of inhaled or oral corticosteroids taken when symptoms worsen may be the best approach for mild persistent asthma. However, they encourage further studies to support this approach, which could reduce medical costs and decrease the adverse effects of medication. Around a quarter of all people with asthma have mild persistent asthma, defined as symptoms on two to six days of the week, or waking in the night due to asthma two or three times a month. It is well established that patients with moderate or severe asthma require anti-inflammatory drugs every day.
Boushey, H A et al. Daily versus as-needed corticosteroids for mild persistent asthma. The New England Journal of Medicine, Vol. 352, April 2005, pp. 1519-1528

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