Although daily treatment with an inhaled corticosteroid has been believed to be the best treatment for mild persistent asthma, that regimen is followed by only about one third of patients.  So, researchers set out  to see what would happen if people with mild, well-controlled asthma took a puff only when they used their rescue medicine for relief of symptoms. The study, called the Best Adjustment Strategy for Asthma in the Longer Term (BASALT) trial, was published in the September 2012  issue of Journal of the American Medical Association.

Study participants were 342 adults with mild-to-moderate, persistent asthma who were followed for 9 months between 2007 and 2010. The investigators looked at three different approaches to the use of inhaled corticosteroids:

• Inhaler assessments and dosage adjustments made every 6 weeks by a physician;
• Inhaler adjustments made every 6 weeks based on measurements of exhaled NO;
• Inhaler adjusted by participants based on their day-to-day symptoms—taking one puff of their ICS for every puff of an albuterol inhaler taken “as needed.”

The researchers found that frequency of flare-ups, symptom severity, and pulmonary function did not differ among the treatment groups; patients who took ICS only when they had symptoms used half as much of the medication, but did not have more severe symptoms, nor did they miss more days of work or school.

This may open a door to a new approach to treatment, according to Homer A. Boushey, professor of Medicine at University of California, San Francisco, who served on the expert committee that developed the current NIH guidelines for managing asthma.

“This is a step forward in asthma management,’ says William J. Calhoun, MD, from the University of Texas Medical Branch and lead author of the study. “It is ‘temporal personalization,’ adjusting medication on a day-to-day basis.”

Source: University of California, San Francisco