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Previous Volume 352:1519-1528 April 14, 2005 Number 15 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Fabbri, L. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

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.

Source Information

From the University of California at San Francisco, San Francisco (H.A.B., J.V.F., S.C.L.); University of Wisconsin, Madison (C.A.S., R.F.L.); Pennsylvania State University College of Medicine, Hershey (T.S.K., V.M.C., T.J.C., E.A.M., N.J.R.); University of Washington, Seattle (S.D.S.); Harlem Lung Center and Columbia University, New York (E.A.D., J.K.F., J.G.F., G.R.P.); Brigham and Women's Hospital and Harvard Medical School, Boston (A.D., M.E.W., E.I.); Thomas Jefferson University, Philadelphia (J.E.F., F.T.L., S.P.P.); and the National Jewish Medical and Research Center, Denver (M.K., R.J.M., S.J.S.).

Full Text of this Article

Related Letters:

Treatment of Mild Asthma
Berti I., Longo G., Visintin S., Chowdhury B. A., Jenkins C. R., Marks G. B., Reddel H. K., Lee D. K.C., Raghupathy A., Brashier B., Salvi S., Boushey H. A., Israel E., Fabbri L. M.
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N Engl J Med 2005; 353:424-427, Jul 28, 2005. Correspondence

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