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Previous Volume 335:841-847 September 19, 1996 Number 12 Next

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ABSTRACT

Background Inhaled -agonists are the most commonly used treatment for asthma, but data suggest that regularly scheduled use of these agents may have a deleterious effect on the control of asthma. We compared the effects of regularly scheduled use of inhaled albuterol with those of albuterol used only as needed in patients with mild chronic, stable asthma.

Methods In a multicenter, double-blind study, we randomly assigned 255 patients with mild asthma to inhale albuterol either on a regular schedule (126 patients) or only as needed (129 patients). The patients were followed for 16 weeks.

Results The primary outcome indicator, peak expiratory air flow measured in the morning, did not change significantly during the treatment period in the scheduled (416 liters per minute after the run-in period and 414 liters per minute after the treatment period) or the as-needed (424 liters per minute at both times) treatment groups (P = 0.71). There were no significant differences between the two groups in peak flow variability, forced expiratory volume in one second, the number of puffs of supplemental albuterol needed, asthma symptoms, asthma quality-of-life score, or airway responsiveness to methacholine. The statistically significant differences between the groups in evening peak flow and in the short-term bronchodilator response to inhaled albuterol were small and judged to be clinically unimportant.

Conclusions In patients with mild asthma, neither deleterious nor beneficial effects derived from the regular use of inhaled albuterol beyond those derived from use of the drug as needed. Inhaled albuterol should be prescribed for patients with mild asthma on an as-needed basis.

Source Information

From Brigham and Women's Hospital and Harvard Medical School, Boston (J.M.D., E.I.); the University of California at San Francisco, San Francisco (H.A.B., J.V.F., S.C.L.); Milton S. Hershey Medical Center, Hershey, Pa. (V.M.C.); Thomas Jefferson University, Philadelphia (J.E.F., S.P.P.); the University of Wisconsin, Madison (R.F.L., C.S.); and the National Jewish Center for Immunology and Respiratory Medicine, Denver (R.J.M., S.J.S.). Additional contributing authors were Reuben Cherniack, M.D. (National Jewish Center for Immunology and Respiratory Medicine, Denver), and Suzanne Hurd, Ph.D. (National Heart, Lung, and Blood Institute, Bethesda, Md.).

Address reprint requests to Dr. Drazen at the Respiratory Disease Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.

Full Text of this Article

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FitzGerald J. M., Salvi S., Pauwels R. A., Tattersfield A. E., Löfdahl C.-G.
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• Pauwels, R. A., Lofdahl, C.-G., Postma, D. S., Tattersfield, A. E., O'Byrne, P., Barnes, P. J., Ullman, A., The Formoterol and Corticosteroids Establishing Th, (1997). Effect of Inhaled Formoterol and Budesonide on Exacerbations of Asthma. NEJM 337: 1405-1411 [Abstract] [Full Text]  
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• IRVIN, C. G., MARTIN, R. J., CHINCHILLI, V. M., KUNSELMAN, S. J., CHERNIACK, R. M. (1997). Quality Control of Peak Flow Meters for Multicenter Clinical Trials. Am. J. Respir. Crit. Care Med. 156: 396-402 [Abstract] [Full Text]  
• DRAZEN, J. (1997). Clinical Pharmacology of Leukotriene Receptor Antagonists and 5-Lipoxygenase Inhibitors. Am. J. Respir. Crit. Care Med. 157: 233S-237 [Abstract] [Full Text]  
• Eggleston, P. A. (1997). Are beta -Adrenergic Bronchodilators Safe?. Pediatrics 99: 729-729 [Full Text]  
• Suissa, S., Ernst, P., Zahger, D., Drazen, J. M., Israel, E., The National Heart, Lung, and Blood Institute's As, (1997). Albuterol in Mild Asthma. NEJM 336: 729-730 [Full Text]  
• (1997). Using {beta}2-stimulants in asthma. DTB 35: 1-4 [Abstract] [Full Text]  
• (1996). REGULAR VS. AS-NEEDED ALBUTEROL FOR ASTHMA. JWatch General 1996: 4-4 [Full Text]  
• O'Byrne, P. M., Kerstjens, H. A.M. (1996). Inhaled {beta}2-Agonists in the Treatment of Asthma. NEJM 335: 886-888 [Full Text]