Study Questions Daily Asthma Meds

By ABC News

Sep 11, 2012 6:18pm

Reported by Maureen Braun, M.D., ABC News Medical Unit:

Millions of patients with asthma may not need to take their medicine every day after all.

Nearly 25 million people in the United States suffer from asthma, and many of them use an inhaled corticosteroid (ICS) medicine two times per day, every day, to prevent asthma symptoms. Unlike albuterol, a medicine that opens the airways and is used only to treat symptoms or asthma attacks, patients on inhaled corticosteroids are told to use this medicine even when they are not having symptoms.

Now, a study in the Journal of the American Medical Association suggests this twice-a-day medication may not be needed.

This may be important news for patients suffering from a disease that not only costs billions in health care dollars, but also leads to missed days of work and school, as well as early death.

Researchers from 10 different institutions in the U.S. looked at 342 adults with mild to moderate asthma who were taking inhaled corticosteroids. They randomly put patients into three groups to study the effects of different medication management approaches.

Members of the first group had their medication adjusted by a physician every six weeks based on standard clinical guidelines. The second group had its medication adjusted every six weeks based on results of a breathing test, and members of the third group adjusted their medication daily based on their symptoms.

Researchers found that patients in the third group — those who used their inhaled corticosteroids only when they had symptoms — did just as well as the patients who used it every day. These patients had no difference in lung function and days missed from school and work, worsening of symptoms, and asthma attacks.

They also had no difference in what is called the reactivity of their lung tissue — the factor behind asthma attacks.

Inhaled corticosteroids are considered generally safe; side effects tend to be mild and include irritation and dryness of the throat as well as an increased risk of thrush, a yeast infection of the tongue and mouth. A few studies, however, suggest the possibility of more serious, systemic consequences, such as decreased growth in children, decreased bone density, and suppression of the immune system. The jury is still out on these effects, though, and these problems may be more likely linked to incorrect use of the drugs.

Experts not involved in the study said the findings are important.

“This is very surprising and very provocative data in that it seems to show that ‘less may be the same’ in the treatment of some patients with persistent asthma,” said Dr. Clifford Bassett, an allergist and immunologist at NYU Langone Medical Center.

Bassett added that although inhaled corticosteroids are very safe drugs, decreasing their use could have major cost benefits.

But physicians also warn that asthma patients — or parents of children with asthma — should not act on these findings without talking to their doctors.

Dr. Andrew Ting, a pediatric pulmonologist at Mount Sinai Medical Center, said he feared that some parents might think this means that they can stop giving their children inhaled corticosteroids every day — despite the fact that in younger patients a daily dose is still believed to be necessary to keep asthma at bay.

“I’m concerned it may be misinterpreted in the pediatric population,” he said, explaining that children differ from adults in the way asthma affects their lungs.

And Bassett said that for all patients, more data is needed before doctors can make a formal recommendation.

“This is one study, we need to get more information as well as clinical data to support this change in regimen,” he said.

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