Less Asthma Medication May Be Feasible for Some
Researchers offer options for well-controlled asthma

(HealthDay News) -- Although inhaled corticosteroids are often considered standard therapy for people with asthma, those with the mild form of the disease might not need to take these drugs all the time if their asthma is well-controlled.

Two studies published in the New England Journal of Medicine found that people with mild asthma might do equally well on inhaled corticosteroids (used regularly or intermittently), so-called rescue medications (such as albuterol) or the oral medication montelukast (Singulair), which blocks the action of substances in the body that cause symptoms of asthma and allergic rhinitis.

"These studies give us some room to step away from current guidelines and show there are many effective ways to treat mild persistent asthma," Dr. Jane Krasnick, chief of allergy at St. John Macomb Hospital in Warren, Mich., told HealthDay .

Asthma medicines can be broadly divided into two categories: bronchodilators and anti-inflammatories, according to the American Lung Association. Bronchodilators are also called rescue medications because they open up the airways during an asthma attack. Albuterol is an example of a rescue medication. Anti-inflammatories help prevent asthma attacks by reducing inflammation in the airways. Corticosteroids are one example of anti-inflammatory medications.

In one study, Italian researchers recruited 455 people with mild asthma to be randomly placed into one of four treatment groups. One group was given a combination corticosteroid/albuterol medication twice daily, another took albuterol as needed, the third group took an inhaled corticosteroid and used albuterol as needed, and the final group used the combination medication and albuterol as needed.

The researchers found that the groups scored similarly on lung function tests, though lung function was best for those taking the combination therapy with the as-needed albuterol.

The second study looked at 500 people with mild, persistent asthma who'd achieved good control of their symptoms using a corticosteroid inhaler twice a day.

One-third of the group continued taking their inhaled corticosteroids twice a day, another third took Singulair daily for four months and the final third used a combination medication, called Advair.

The researchers found that symptom-free days were similar among the groups. About 20 percent in the two groups using inhaled corticosteroids, and about 30 percent of the Singulair group, were classified as having a treatment failure -- meaning they had a decline in lung function, a need for oral steroid treatment or an emergency visit caused by asthma.

"If you look at the percent of days free of symptoms, people did well across the board," Dr. Stephen Peters, lead author of the study and a professor of pediatrics and pulmonary internal medicine at Wake Forest University Baptist Medical Center , told HealthDay .

"If you're doing well on twice-a-day therapy, and you don't mind taking the medication, stick with it. This is still the best option for most," Peters said. "If you have allergic rhinitis as well as asthma, montelukast is approved for that, and that might be a good reason to try it."

Both studies were funded by pharmaceutical companies that manufacture asthma medications.

And Krasnick offered a note of caution. "There may be some patients who can take medications on an as-needed basis, but you have to make sure you know what to do if you start to get into trouble," she said.

On the Web

To learn more about asthma, visit the National Heart, Lung, and Blood Institute.

SOURCES: HealthDay News ; Stephen Peters, M.D., professor of pediatrics and pulmonary internal medicine and associate director, Center for Human Genomics, Wake Forest University Baptist Medical Center, Winston-Salem, N.C.; Jane Krasnick, M.D., chief of allergy, St. John Macomb Hospital, Warren, Mich.; May 17, 2007, New England Journal of Medicine ; American Lung Association (www.lungusa.org)
Author: Serena Gordon
Publication Date: May 31, 2008
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