How Do Inhaled Steroids and Long-Acting Antimuscarinics Perform in Mild Asthmatics Without Eosinophilia?

Inhaled steroids (ICS) are first-line agents for patients with mild asthma, but whether they are effective in the roughly 50% of patients with noneosinophilic asthma is unclear. Researchers compared the effectiveness of daily ICS versus long-acting antimuscarinic agents (LAMAs) in patients with mild asthma and <2% sputum eosinophil counts.

In a double-blinded crossover trial, 295 adolescent and adult patients with mild asthma (73% had no eosinophilia) were treated with daily mometasone (an ICS), tiotropium (Spiriva; a LAMA), or placebo for 12 weeks each. A composite asthma score (which encompassed lung function and symptoms), was similar in all three groups among patients without eosinophilia. As expected, patients with sputum eosinophilia o…