People with mild asthma can control symptoms without daily steroids
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《英国医生杂志》
Adults with longstanding, mild, but persistent asthma who used corticosteroids only when their symptoms worsened were no worse off than those who used regularly scheduled treatment to control symptoms with either inhaled budesonide (Pulmicort) or oral zafirlukast (Accolate), a study has found.
Although treatment guidelines recommend daily corticosteroids as anti-inflammatory treatment to control mild, persistent asthma, research already indicates that most patients with mild asthma are using their treatment intermittently because they do not see the need for daily treatment.
The new results show that this strategy is acceptable if patients follow a strict action plan based on symptoms to guide the use of inhaled or oral corticosteroids when signs or symptoms of asthma worsen (New England Journal of Medicine 2005;352:1519-28).
The researchers, led by Dr Homer Boushey of the University of California at San Francisco, evaluated the efficacy in patients with mild, persistent asthma of intermittent, short course corticosteroid treatment guided by a symptom based action plan alone. Over a year they compared this treatment on its own with the same treatment but with the addition of daily treatment with either inhaled budesonide or oral zafirlukast.
Among the recommendations in the plan was the instruction to patients to start using corticosteroids if they were awakened by symptoms of asthma three or more times in a two week period or on two consecutive nights, if their relief from an inhaler containing the ?agonist salbutamol was lasting less than four hours, or if they found themselves using their salbutamol inhalers for relief of symptoms daily for more than seven days.
Between February 2000 and May 2002 the study recruited 225 adult patients from six centres in the United States and randomised to the double blind trial. The primary outcome was morning peak expiratory flow (PEF). Other outcomes included forced expiratory volume in one second (FEV1) before and after bronchodilator treatment, frequency of exacerbations, degree of asthma control, number of symptom free days, and quality of life.
Researchers found that the three treatments produced similar increases in morning PEF of about 7.8% (an increase of 32 litres per minute) in all groups and similar rates of asthma exacerbations (P=0.24), even though the intermittent treatment group took budesonide for only half a week of the year, on average.
Daily zafirlukast treatment, however, did not differ significantly from intermittent treatment in any of the measured outcomes.
"We found that daily treatment with budesonide (but not zafirlukast) was associated with a significant increase in the number of symptom-free days and a trend toward improvement in the scores for a weighted symptom utility index, but not in asthma-related quality of life," the authors wrote.
"This lack of improvement in the quality of life may reflect the light burden of symptoms of mild asthma. In asthma of this severity, symptoms are occasional and are usually promptly relieved by treatment with an inhaled bronchodilator. Whether the increase in symptom-free days is worth the costs of treatment, both fiscal and with respect to long-term side effects, may thus be an individual, subjective judgment best left to the patient and his or her health care provider."(Scott Gottlieb)
Although treatment guidelines recommend daily corticosteroids as anti-inflammatory treatment to control mild, persistent asthma, research already indicates that most patients with mild asthma are using their treatment intermittently because they do not see the need for daily treatment.
The new results show that this strategy is acceptable if patients follow a strict action plan based on symptoms to guide the use of inhaled or oral corticosteroids when signs or symptoms of asthma worsen (New England Journal of Medicine 2005;352:1519-28).
The researchers, led by Dr Homer Boushey of the University of California at San Francisco, evaluated the efficacy in patients with mild, persistent asthma of intermittent, short course corticosteroid treatment guided by a symptom based action plan alone. Over a year they compared this treatment on its own with the same treatment but with the addition of daily treatment with either inhaled budesonide or oral zafirlukast.
Among the recommendations in the plan was the instruction to patients to start using corticosteroids if they were awakened by symptoms of asthma three or more times in a two week period or on two consecutive nights, if their relief from an inhaler containing the ?agonist salbutamol was lasting less than four hours, or if they found themselves using their salbutamol inhalers for relief of symptoms daily for more than seven days.
Between February 2000 and May 2002 the study recruited 225 adult patients from six centres in the United States and randomised to the double blind trial. The primary outcome was morning peak expiratory flow (PEF). Other outcomes included forced expiratory volume in one second (FEV1) before and after bronchodilator treatment, frequency of exacerbations, degree of asthma control, number of symptom free days, and quality of life.
Researchers found that the three treatments produced similar increases in morning PEF of about 7.8% (an increase of 32 litres per minute) in all groups and similar rates of asthma exacerbations (P=0.24), even though the intermittent treatment group took budesonide for only half a week of the year, on average.
Daily zafirlukast treatment, however, did not differ significantly from intermittent treatment in any of the measured outcomes.
"We found that daily treatment with budesonide (but not zafirlukast) was associated with a significant increase in the number of symptom-free days and a trend toward improvement in the scores for a weighted symptom utility index, but not in asthma-related quality of life," the authors wrote.
"This lack of improvement in the quality of life may reflect the light burden of symptoms of mild asthma. In asthma of this severity, symptoms are occasional and are usually promptly relieved by treatment with an inhaled bronchodilator. Whether the increase in symptom-free days is worth the costs of treatment, both fiscal and with respect to long-term side effects, may thus be an individual, subjective judgment best left to the patient and his or her health care provider."(Scott Gottlieb)