Do Patients with Mild Asthma Need Daily Inhaled Steroids?
According to national guidelines, mild persistent asthma is defined by a need for ß-agonist treatment more than 2 days per week (but less than daily), asthma-related nighttime awakenings more than twice per month (but not more than once weekly), or spirometric criteria (http://www.nhlbi.nih.gov/health/prof/lung/asthma/practgde/practgde.pdf). Daily inhaled corticosteroids are recommended for such patients, but is such treatment really necessary? In this partially industry-supported, multicenter trial, 225 adults with mild persistent asthma were randomized to receive twice-daily inhaled budesonide plus placebo tablets, twice-daily oral zafirlukast plus placebo inhaler, or twice-daily double placebo. Patients used inhaled albuterol as needed; in addition, all were instructed in self-treatment with a 10-day course of inhaled high-dose budesonide or a 5-day course of oral prednisone for worsening symptoms. After 1 year, the groups did not differ significantly in the primary outcome (change
