As-needed steroid therapy seems OK for mild asthma

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For patients with mild persistent asthma, using inhaled or oral corticosteroids on an as-needed basis, rather than continuously, may be an option for keeping their condition under control, according to a new report.

Daily steroid therapy is currently recommended for people with mild persistent asthma, but analysis of prescription patterns suggest that many patients are using steroid drugs only when symptoms arise.

To see if this might be a reasonable approach, Dr. Homer A. Boushey of the University of California at San Francisco, and colleagues studied 225 asthma patients.

They were randomly assigned to an as-needed steroid regimen or daily steroid therapy for 1 year. Some intermittent-steroid users were also given a different type of asthma control medication, zafirlukast, to take daily.

The three treatments produced similar increases in morning peak expiratory flow, and rates of asthma flare-ups were similar. This was the case despite little use of the inhaled steroid in the as-needed group, the team reports in this week’s New England Journal of Medicine.

In a related editorial, Dr. Leonardo M. Fabbri, from the Policlinico di Modena in Italy, comments that the new findings may change clinical practice “since the option of intermittent treatment with inhaled corticosteroids complies with the philosophy of achieving and maintaining control of asthma with the least amount of medication.”

SOURCE: New England Journal of Medicine, April 14, 2005.

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