Effective mild asthma management with lower steroid doses

A groundbreaking study published in the New England Journal of Medicine could lead to a reduction in the amount of steroid medication patients need to take to manage their mild asthma. Lead investigator Dr. Mark FitzGerald, a researcher with Vancouver Coastal Health Research Institute (VCHRI), examined whether patients with mild asthma could benefit from a combination medication versus twice-daily inhaled steroids or non-steroid reliever inhalers on an as-needed basis. 

“Patients can have a tendency to overuse medication that relieves symptoms, but underuse medication that can prevent symptoms from occurring.”   

FitzGerald and colleagues’ double-blind study involved almost 4,000 patients 12 years of age or older with mild asthma. Asthma symptoms, such as difficulty breathing, are caused by inflammation or swelling in the airways.

Approximately 50 to 75 per cent of asthma patients have mild asthma, which can be managed effectively if medication is taken as prescribed.

Many asthma patients are prescribed inhaled corticosteroids, which help reduce inflammation and prevent asthma symptoms and exacerbations. However, many do not take this effective treatment and overuse the short-acting reliever inhaler they are prescribed for use when they experience difficulty breathing.

A possible new treatment to prevent asthma exacerbations 

During the one-year clinical trial, patients were separated into three groups and given different medications and treatment plans. One third of patients received a budesonide-formoterol inhaler to use on an as-needed basis, plus a twice-daily placebo. Another third received terbutaline—a short-acting reliever inhaler used to manage mild asthma symptoms—to use as needed, plus a twice-daily placebo. The final group received as-needed terbutaline, plus twice-daily budesonide maintenance therapy. 

Dr. Mark FitzGerald is the director of the Centre for Heart and Lung Health and a senior scientist at the Centre for Clinical Epidemiology and Evaluation. He is a member of the Respiratory Medicine Divisions at UBC and Vancouver General Hospital and co-director of the UBC Institute for Heart and Lung Health.

The results showed that the group that took budesonide-formoterol had better overall control of their asthma symptoms and a reduced risk of asthma exacerbation than those in the terbutaline only group. 

The budesonide-formoterol treatment was similar to the terbutaline plus twice-daily budesonide maintenance therapy in terms of its effectiveness at reducing the risk of asthma exacerbations. However, the budesonide-formoterol group did not need to take corticosteroids twice daily and inhaled only 17 per cent of the steroids that the terbutaline plus twice-daily maintenance group inhaled.

“With budesonide-formoterol, patients can manage their mild asthma and prevent exacerbations with much lower steroid doses than those who take regular inhaled corticosteroids.”  

Results of this trial could have huge implications for the 334 million people worldwide who suffer from asthma, but may be reluctant to take inhaled corticosteroids on a daily basis to manage their symptoms. It could also be a cost-effective measure, as it requires less medication overall.

“Reliever medications like terbutaline do not treat inflammation, which is the underlying cause of asthma symptoms,” notes FitzGerald. “Inhaled corticosteroids like budesonide do treat inflammation, which helps to prevent asthma exacerbations and can decrease the use of and reliance on reliever medications.” 

“Our research shows that symptom control and treatment efficacy can be achieved with an as-needed combined medication for patients with mild asthma.” 

An accompanying study co-investigated by Fitzgerald garnered similar findings. Both studies are scheduled to be submitted to regulatory agencies for approval and could soon result in a novel new approach to treating mild asthma.