Mild Asthmatics May Do Well With Less Medicine

Studies confirm step-down recommendations for those with controlled asthma.

By Serena Gordon
HealthDay Reporter
Wednesday, May 16, 2007; 12:00 AM

Copyright © 2007 ScoutNews, LLC. All rights reserved.

WEDNESDAY, May 16 (HealthDay News) -- People with well-controlled, mild asthma might have more treatment options than they, and possibly their doctors, thought.

A pair of studies in the May 17 issue of the New England Journal of Medicine compared the gold standard of treatment for mild, persistent asthma -- inhaled steroids twice a day, every day -- to combination medications that include inhaled corticosteroids and rescue medications known as beta agonists, or to the oral medication, montelukast (Singulair). In the end, there was scant difference between the different medications.

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

Dr. Stephen Peters, lead author of one of the studies, said that while twice-a-day inhaled corticosteroids are probably still the best treatment choice, "there are alternatives that may be suitable to you" if you don't like using an inhaler twice a day or find it too hard to remember to take your medication twice a day.

"If you have good asthma control, you can think about stepping down your therapy," he added.

In Peters' study, the researchers recruited 500 people with mild, persistent asthma who already had their asthma symptoms well-controlled by taking 100 micrograms of inhaled fluticasone twice daily.

One hundred and sixty-nine people from this group were randomly assigned to continue taking fluticasone twice daily, while another 166 were assigned to take either 5 milligrams or 10 milligrams of montelukast once each night for 16 weeks. The final 165 people were asked to use the combination medication known as Advair once each night. Advair includes 100 micrograms of fluticasone and 50 micrograms of salmeterol, a long-acting beta agonist.

People in both the fluticasone and the fluticasone plus salmeterol group fared about the same, with both groups experiencing about a 20 percent treatment failure. About 30 percent of the montelukast group experienced a treatment failure. For the purposes of this study, Peters and his colleagues very broadly defined treatment failure to include a decline in lung function, the need for oral steroids or an urgent care visit due to asthma.