Intermittent Asthma Treatment

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Do mild asthmatics do just as well on intermittent steroids? This is an article that kind of scares me. The headlines and first few paragraphs talk about fewer medications, billions in cost savings, and adults being “freed” from daily dosing, which is all great, but the details of this study are very important.

The researchers divided 340 patients into three groups: daily inhaled corticosteroid (ICS) therapy, ICS dose adjustment based on nitric oxide, and ICS treatment only when symptomatic. All the groups had similar outcomes. One of the study authors goes on to suggest that the asthma guidelines should be changed to allow for intermittent ICS treatment in mild asthmatics.

Not so fast my friend. Your study has some serious limitations.

First, this is a really small study. Each arm had only ~110 patients. Second, the study only ran for nine months. That too short an amount of time to capture exacerbations in a mild asthma population.

Editorial commentary on the study had much more tempered enthusiasm, stating “There is no compelling rationale to alter the current approach to inhaled corticosteroid dosing for mild or mild to moderate persistent asthma.” I agree. It is an interesting approach, but it needs to be studied in more patients for longer periods before recommending it as routine therapy. Stay tuned.

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