RESEARCH - Daily versus As-Needed Steroids for Mild Persistent Asthma

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NEJM

Volume 352:1519-1528; Number 15

April 14, 2005

Daily versus As-Needed Corticosteroids for Mild Persistent Asthma

ABSTRACT

Background Although guidelines recommend daily therapy for patients with

mild persistent asthma, prescription patterns suggest that most such

patients use these so-called controller therapies intermittently. In

patients with mild persistent asthma, we evaluated the efficacy of

intermittent short-course corticosteroid treatment guided by a symptom-based

action plan alone or in addition to daily treatment with either inhaled

budesonide or oral zafirlukast over a one-year period.

Methods In a double-blind trial, 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.

Results The three treatments produced similar increases in morning PEF (7.1

to 8.3 percent; approximately 32 liters per minute; P=0.90) and similar

rates of asthma exacerbations (P=0.24), even though the

intermittent-treatment group took budesonide, on average, for only 0.5 week

of the year. As compared with intermittent therapy or daily zafirlukast

therapy, daily budesonide therapy produced greater improvements in

pre-bronchodilator FEV1 (P=0.005), bronchial reactivity (P<0.001), the

percentage of eosinophils in sputum (P=0.007), exhaled nitric oxide levels

(P=0.006), scores for asthma control (P<0.001), and the number of

symptom-free days (P=0.03), but not in post-bronchodilator FEV1 (P=0.29) or

in the quality of life (P=0.18). Daily zafirlukast therapy did not differ

significantly from intermittent treatment in any outcome measured.

Conclusions It may be possible to treat mild persistent asthma with short,

intermittent courses of inhaled or oral corticosteroids taken when symptoms

worsen. Further studies are required to determine whether this novel

approach to treatment should be recommended.

http://content.nejm.org/cgi/content/abstract/352/15/1519

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