Treatment Changes for Mild Asthma?

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Two new trials could lead to changes in the way mild asthma is managed. The findings were presented on Sunday at the American Thoracic Society International Conference and published in the New England Journal of Medicine.

In the first trial, which was randomized, open-label, and industry-supported, as-needed budesonide-formoterol was superior to as-needed albuterol — and did not differ significantly from maintenance budesonide with as-needed albuterol — for preventing overall asthma exacerbations in adults with mild disease. Severe exacerbations also occurred less often with as-needed budesonide-formoterol than with the other treatments.

In the second study, researchers found that most patients aged 12 years and older with mild persistent asthma had low sputum eosinophil levels. When these patients received mometasone (an inhaled glucocorticoid), tiotropium (a long-acting muscarinic antagonist [LAMA]), and placebo in a randomized, crossover design, there were no differences in their responses to either active treatment relative to placebo.

An editorialist concludes, "Evidence is building to question the role of as-needed [short-acting beta-agonists] as the step 1 treatment for mild intermittent asthma. Furthermore, larger trials with adequate power to detect all important asthma outcomes are needed to evaluate whether LAMAs would be an effective alternative for the treatment of persistent asthma in patients who do not have eosinophilic airway inflammation."

Dr. David Amrol of NEJM Journal Watch General Medicine took a closer look at these studies. See his take in the last link below.