In this trial, patients with mild persistent asthma who were receiving an inhaled corticosteroid twice daily were given the same treatment or were switched either to an inhaler containing a corticosteroid and a long-acting beta-agonist or to a leukotriene modifier. There was no difference in asthma control between the two corticosteroid groups. The patients switched to the leukotriene modifier had more frequent asthma exacerbations, but there was no difference in the percentage of symptom-free days among the three groups.

Patients with mild persistent asthma are often advised to use inhaled corticosteroids on a regular schedule. In this trial, such patients treated themselves with inhaled beclomethasone (250 µg per puff) and albuterol (100 µg per puff) only when they had symptoms of asthma. The mean morning peak expiratory flow rate in this group was similar to that in the group receiving inhaled corticosteroids regularly. Controller treatments may not be needed on a regular basis in patients with asthma.

The authors of this study report that young adults with very low birth weights have higher levels of insulin resistance, glucose intolerance, and blood pressure as compared with young adults who were born at term. Since lifestyle interventions may help in preventing type 2 diabetes and hypertension, recognizing that formerly low-birth-weight babies are at apparent increased risk might provide opportunities for intervention.

A 62-year-old woman who reported dysgeusia was found to have a serum sodium level of 122 mmol per liter. The serum osmolality was 250 mOsm per kilogram of water, and the urinary osmolality 635 mOsm per kilogram of water. Chest CT showed a mass in the lower lobe of the left lung, which proved to be a small-cell carcinoma. How should her hyponatremia be treated?

The unique features of the human immunodeficiency virus (HIV) envelope protein have thwarted efforts to identify a protective vaccine. However, a vaccine that does not prevent infection but reduces HIV levels and preserves memory CD4+ T cells could benefit both the recipient and the community at risk. Several vaccines that induce T-cell responses are now in early clinical trials. This review summarizes the science and strategies in the search for an effective vaccine to control HIV infection.

A 20-year-old woman with a history of severe asthma was found at home in an unresponsive state and was taken to the emergency room. Asthma had been diagnosed at 4 years of age, with multiple exacerbations thereafter that required hospitalization. The patient and her mother had not followed environmental and medication regimens. In the weeks before admission, the patient had visited many emergency rooms and clinics because of exacerbations. She was pronounced dead shortly after arrival. An autopsy was performed.

This interactive Journal feature presents the case of a 30-year-old woman with mild persistent asthma treated with inhaled beclomethasone twice daily plus the use of an as-needed albuterol inhaler. Although her disease is well controlled, she desires less treatment. Three possible treatment options are presented, together with expert opinion on each. Which treatment option do you recommend? At www.nejm.org, you can vote for one and then, if you wish, submit a comment about your clinical decision. Voting results and a broad selection of comments will be posted on the Web site.