It may be possible to treat mild persistent asthma with short, intermittent courses of inhaled or oral corticosteroids taken when symptoms worsen.

A study, led by Homer A Boushey from University of California-San Francisco, compared lung function and the number of episodes of asthma in the presence and absence of daily treatment with either an inhaled corticosteroid ( Budesonide ) or a leukotriene-receptor antagonist ( Zafirlukast ).

Current guidelines from the National Asthma Education and Prevention Program recommend daily therapy for patients with mild persistent asthma, although prescription patterns suggest that most such patients use the drugs intermittently.

A total of 225 adults underwent randomization.

The primary outcome was morning peak expiratory flow ( PEF ).
Other outcomes included the forced expiratory volume in one second ( FEV1 ) before and after bronchodilator treatment, the frequency of exacerbations, the degree of asthma control, the number of symptom-free days, and the quality of life.

The three treatments produced similar increases in morning PEF ( 7.1 to 8.3 percent; approximately 32 liters per minute ) and similar rates of asthma exacerbations, even though the intermittent-treatment group took budesonide, on average, for only 0.5 week of the year.

Compared with intermittent therapy or daily Zafirlukast therapy, daily Budesonide therapy produced greater improvements in pre-bronchodilator FEV1, bronchial reactivity, the percentage of eosinophils in sputum, exhaled nitric oxide levels, scores for asthma control , and the number of symptom-free days, but not in post-bronchodilator FEV1 or in the quality of life.

Daily Zafirlukast therapy did not differ significantly from intermittent treatment in any outcome measured.

Source: The New England Journal of Medicine, 2005


XagenaMedicine2005