Study: No difference between daily, as needed inhaled steroid use
A study in the Journal of the American Medical Association found no measurable difference between mild-to-moderate asthma patients who used inhaled corticosteriods daily and those who used inhaled corticosteriods only when symptoms occurred. Researchers at University of Texas Medical Branch at Galveston tracked outcomes for 340 adults with mild-to-moderate, persistent asthma randomly chosen for ongoing, physician-monitored care; continuous care based on an periodic breath tests measuring levels of nitric oxide; or care based on symptoms alone, with steroids given only as flare-ups occurred. They measured outcomes over nine months, including bronchial reactivity, lung function, symptom exacerbation, and sick days. The team found no measurable difference in any of the outcomes, regardless of treatment approach.
Editorial comments from ACAAI President Stanley Fineman, MD, MBA, FACAAI
This study from the Asthma Clinical Research Network studied three strategies for monitoring asthma control in patients with mild-moderate persistent asthma. Physician assessment was compared to biomarker-based (eNO) compared to symptom-based management for asthma control with the end point being time to treatment failure. Interestingly, the treatment failure rates over the nine-month study period were similar for all three strategies. The fact that the symptom-based management strategy, which parallels the 'real world' patient practice, met similar end points must be interpreted with caution because the study was not powered to demonstrate superiority, but rather to show equivalence. As we know, a single study doesn't change practice patterns, although it will be critical that we monitor research using symptom-based, and, ultimately, patient-driven adjustment of asthma control medication in the future. The implications for optimal patient care are critical.
Editorial comments from ACAAI President-Elect Richard Weber, MD, FACAAI
My take on the BASALT article is that Stan's cautionary stance is appropriate. My additional thoughts are two: 1) The BASALT study raises the issue of how much maintenance inhaled corticosteroid is necessary or appropriate in mild-to-moderate asthma — but with the caveat that severe asthma is a different issue and was not addressed by this study, and therefore these results should not be generalized to the management of severe asthma. 2) BASALT provides further support to previous studies suggesting that need for rescue bronchodilator use implies increased inflammation —whatever the trigger — and that it may be appropriate to use additional anti-inflammatory therapy (inhaled corticosteroid) with any use of rescue bronchodilator.
What do you think? We welcome your comments.
Online asthma intervention may be more effective for depressed teens
Online asthma interventions may be more effective for urban teens with depression than with those without depression, according to a study in Annals of Allergy, Asthma and Immunology. Researchers at Children's Hospital of Michigan and Henry Ford Health System, Detroit, analyzed data using logistic regression from a randomized controlled trial of a web-based asthma management intervention for urban teens to study the effect of coexisting depressive symptoms on the effectiveness of self-management interventions. Among teens depressed at baseline, emotional quality of life scores at follow-up were significantly higher in the treatment group compared with the control group.
Obesity and asthma linked in senior population
Among those 65 and older, asthma risk increases in proportion to an increase in BMI or abdominal subcutaneous adiposity, according to a study in Annals of Allergy, Asthma and Immunology. Scientists in South Korea studied 994 participants (aged=65 years) in the Korean Longitudinal Study on Health and Agingusing multivariate logistic regression tests to investigate the mechanisms of association between obesity and asthma in the senior population. The authors said factors such as abdominal subcutaneous adiposity and sarcopenia warrant further investigations to identify their potential roles in obesity and asthma in this population.