New Study Could Change Treatment for Asthma

Most adults who have mild or moderate asthma are told to use their inhalers twice daily, even if they don't have symptoms. The medicine in those inhalers are corticosteroids,

which open a person's airways and decrease mucus so it's easier to breathe. Inhaled corticosteroids are the most common and the most effective form of therapy for asthma.

With asthma, the airways of the lungs become inflamed and swollen. It's triggered by a wide range of factors, some genetic, some environmental. Dust, air pollution or smoke can set off an asthma attack. Change of seasons when there are a lot of particles in the air can also trigger an attack.

Frank Grizzaffi knows this routine well.

“There was a regime that I was supposed to follow, it was two puffs in the morning and two puffs in the evening,” said Grizzaffi.

That was before Grizzaffi participated in a study that involved 10 academic centers and more than 300 adults with mild to moderate asthma.

The doctors evaluated the patients and determined the lowest possible dose of medication that would control their asthma. Dr. William Calhoun led the study.

“The amount of corticosteroid that a patient received during the trial was dependent upon the amount of symptoms they had. When they had fewer symptoms they got less steroid, when they had more symptoms they got more steroid,” he said.

After adjusting medication, doctors looked at three different ways of treating the patients.

One group received their adjusted dose of steroids and took them as usual. Another group had their steroid levels adjusted after taking sophisticated breath tests for asthma and a third group was told to use inhalers only when their symptoms flared up.

What they found was that patients in this last group did just as well as those in the other two groups. The major difference is they only used half as much medication.  

“The symptoms-based arm resulted in a reduced use of inhaled corticosteroids, a 50 percent reduction. It also resulted in a reduction in exacerbation in the autumn, a time when exacerbation are typically high and it also resulted in a reduction in absenteeism from school or work,” said Calhoun.

These findings could change international standards of care. It would reduce costs because patients would need less medication and it would also limit long-term exposure to corticosteroids.

Under his doctor's care, Frank Grizzaffi no longer needs to follow his old regimen.

“I’ll take one puff in the morning and that usually takes care of it the rest of the day. I feel great, I feel really good,” he said.

Dr. Calhoun advises patients with mild to moderate asthma to check with their doctors to see if this strategy might work for them. The study was published in the Journal of the American Medical Association.