New study reveals daily corticosteroid therapy may not be needed for mild to moderate asthma
Researchers from the University of Texas Medical Branch, Galveston, and study’s findings suggest a new treatment approach which would reduce pharmacy cost, allow flexibility to manage the condition and limit long-term exposure to corticosteroids.View slideshow: Alternative medical approach might help reduce your asthma or allergy symptoms,
According to the public release 25 million Americans suffer from asthma, with the disease costing around $3,3000 each year in medical expenses, missed days of school and work and early deaths.
The assumption is that asthma is always present even when dormant, so it should be treated continuously with anti-inflammatory drugs (corticosteroids) whether or not symptoms are present.
The accepted protocol treatment is twice daily use of corticosteroids and uses a rescue inhaler of albuterol if symptoms should occur. Physicians adjust corticosteroids at six week intervals based on symptom assessment, number of times using the rescue inhaler and pulmonary function.
According to the context of the study “No consensus exists for adjusting inhaled corticosteroid therapy in patients with asthma.”
Dr. William Calhoun, MD, FACP, FCCP, FAAAAI.FACAAI, vice chair for research, Department of Internal Medicine, and fellow associates conducted a randomized, three-group, placebo-controlled, multiply double-blind trial consisting of 342 patients with mild to moderate asthma.
Patients were randomly assigned to one of three groups; physician-assessment-based adjustment (PABA), bio-marker adjustment (BBA) in which a patient's levels of exhaled nitric oxide are monitored on a regular basis; and symptom-based adjustment (SBA), in which inhaled steroid medication is taken only when symptoms occur.
The researchers looked at several outcomes including lung function, days missed from school/work and exacerbation of symptoms and attacks, for each adjustment regimen over the course of nine months. The nine month time frame had allowed for adjustment and to account for seasonal variations.
Researchers had found no measurable difference in outcomes among the three treatment groups.
The study also revealed a five percent annual treatment failure and rising to ten percent failure in autumn and winter. Researchers believed this was due to a multitude of triggers which had included fall allergens, increase of mold or indoor pollution, exposure to viral infections and other common triggers.
Dr. Calhoun stated "SBA has the potential to allow us to personalize therapy in real time.” “This is a vast improvement over current methods whereby even if a patient regularly sees a physician for reassessment, by the time the medication is adjusted, the patient can be six weeks or more behind the curve.”
Dr. Bill Ameredes, PhD, associate professor, division of pulmonary and critical care medicine, and co-author of study states "There are often several orders of asthma symptom progression before an asthma attack ultimately occurs, resulting in a treatment failure or hospitalization.” "Patients using the SBA regimen can treat their symptoms on the spot which may prevent conditions from escalating to a full-blown attack. Further, since ICS have a longer duration of effect, patients will continue to reap the benefits from the initial SBA treatment days later, compared to using just a rescue inhaler."
Also, in addition researchers had found good asthma control and be accomplished using half the dose of inhaled steroids when the symptom based adjustment approach was used which could possibly provide pharmacy cost advantages.
Researchers also pointed out that symptom based use reduce the possible risks of long term corticosteroid use. The risks include accelerated cataract development, vocal cord weakness and oral yeast infections.
In a final statement Dr. Calhoun stated "The current protocol of daily ICS use is effective but the flexibility and immediate probable cost savings for asthma medicine that a symptom-based approach may offer will appeal to many patients.” "We hope our findings prompt patients to talk with their doctors and become more active participants in effectively managing their condition."
This study is published in the September 12th issue of the Journal of the American Medical Association.
Among the common side effects of corticosteroids include muscle weakness, weight gain, blurred vision, osteoporosis, high blood pressure and cataracts or glaucoma.
To minimize the side effects of corticosteroids talk to your physician about lower dosage or intermediate dosing.