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Current U.S. guidelines recommend inhaled steroids (ICS) as first-line treatment for patients with persistent asthma; however, for patients with normal lung function, rare exacerbations, and symptoms fewer than thrice weekly, only as-needed, short-acting bronchodilators are recommended. This approach is universally accepted, but it is not based on clinical evidence. In the START trial, researchers examined the effectiveness of low-dose budesonide within 2 years of diagnosis in adults and children with mild asthma (NEJM JW Pediatr Adolesc Med Jun 2003 and Lancet 2003; 361:1071).
In this post hoc analysis of START data, researchers evaluated 4098 patients with symptoms fewer than 3 days weekly who were randomized to daily budesonide (400 μg in…