Mild asthma can be controlled with once-a-day treatment

May 16 2007

According to new research, for some people suffering from mild asthma which is controlled with twice-daily use of inhaled steroids, once a day may be enough.

Asthma is an inflammation of the airways that makes breathing difficult; symptoms can include wheezing, shortness or breath, coughing and chest tightness.

Researchers at Wake Forest University Baptist Medical Center and 20 other centers took part in a study involving people with mild asthma.

The study, involved 500 children and adults with mild asthma and was conducted by the American Lung Association’s Asthma Clinical Research Centers.

The aim was to find out if patients whose symptoms were well controlled on twice daily inhaled corticosteroid could scale down their medication.

The participants' asthma was treated with twice-daily inhaled fluticasone propionate, a commonly prescribed synthetic steroid designed to suppress inflammation within the airways that can cause narrowing.

Asthma is considered mild, but persistent, when symptoms occur more than two times a week or cause the patient to awaken during the night more than twice a month.

The standard treatment for mild-persistent asthma is twice-daily use of an inhaled steroid to prevent symptoms and sufferers can also take additional drugs such as the inhaler albuterol, known as "rescue" therapy, to treat symptoms.

According to Dr. Stephen P. Peters, the lead author, who is a professor of pediatrics and associate director of the Center for Human Genomics, the majority of people with asthma have mild disease.

The study group were randomly divided into three groups; one group continued to take Flovent twice a day for 16 weeks, while the two other groups took alternative therapies: either a combination of fluticasone propionate and salmeterol in a single inhaler once daily or the oral medication montelukast that blocks chemicals produced by the body that cause inflammation, which was also taken once daily.

Salmeterol, used in the combination therapy, is a long-acting bronchodilator, or a drug that relaxes and opens the airways.

Treatment failure rates were measured among the three groups and included hospitalization or urgent medical care, the need for additional medications for asthma, a decline in lung function, or the need to take more than 10 puffs a day of a "rescue" inhaler for two consecutive days.

The researchers found that the groups taking twice-daily fluticasone and once-daily fluticasone/salmeterol both had a treatment failure rate of 20 percent, while the group taking montelukast, had a 30 percent failure rate.

Dr. Peters says the study suggests that patients whose asthma is well controlled on twice-daily fluticasone can be switched to once-daily flucitasone/salmeterol without increased rates of treatment failure.

He says even though montelukast had a higher rate of treatment failure than the inhaled medications, it can also be considered an option for some patients, since the majority of patients also did well on this treatment.

Dr. Peters says patients should find a therapy that works for them and fits their desires, preferences and lifestyle and while the group on the combination inhaler therapy clearly did better than those on the oral montelukast therapy, it is important to note that 70 percent of patients on this oral therapy did well according to the treatment failure criteria, and were symptom-free on 79 percent of days.

The study found that patients on fluticasone/salmeterol once daily were symptom-free 83 percent of days and those on fluticasone/salmeterol were symptom-free for 86 percent of days.

Most people were able to switch to a less frequent treatment without too many problems.

According to Dr. Peters, a medication’s effectiveness is determined by how well it works when it is taken as prescribed and how well patients adhere to the therapy.

He suggests that patients may adhere better to therapy that is required once a day or that involves taking a pill rather than using an inhaler.

Also while the risks of low-dose steroids are small, some patients may perceive a risk and be more willing to take the drugs if they are only required once a day.

Dr. Peters advises patients who are doing well with the twice a day inhaled corticosteroid treatment to consult their doctor if they want to try other options

The study results are reported in the current issue of the New England Journal of Medicine.