Chest
Clinical InvestigationsIncreased Inhaled Bronchodilator vs Increased Inhaled Corticosteroid in the Control of Moderate Asthma
Section snippets
Methods
Immediately on completion of a randomized double-blind crossover study comparing regularly scheduled with “on-demand” inhaled β-agonist treatment,9 subjects were offered the opportunity to participate in a further study to determine the effect of increasing the daily dosage of inhaled corticosteroid on control of asthma. In the original double-blind study, subjects with mild or moderate asthma inhaled either dry powder fenoterol 400 µg or placebo four times daily for 24 weeks, then crossed over
Results
Of the 34 subjects participating in this study, 32 provided complete data for analysis. Two subjects lost 37 and 54 days, respectively, of their diaries, and so were excluded. Twenty-six of the 32 subjects had used inhaled corticosteroids during periods A and B, in doses ranging from 150 to 2,000 µg daily, while six subjects had not previously used inhaled corticosteroids in any dosage. The 32 subjects completing this study were representative of the 64 subjects in the initial study of
Discussion
This study has demonstrated that increasing the dose of inhaled corticosteroid, in conjunction with use of an inhaled β-agonist only on demand, provided a substantially greater beneficial effect on control of asthma than increasing inhaled β-agonist by regular scheduled doses of a potent β-sympathomimetic agent four times daily. Symptoms were suppressed or eliminated, especially at night, morning PEFR increased, and the need for β-agonist was reduced substantially. These findings extend other
Acknowledgments
The authors thank the subjects for their willingness to participate in this lengthy study, and Marilyn Lucas, Denise Yates, and Qingqing Li for their technical assistance.
References (27)
- et al.
Management of asthma in general practice
Respir Med
(1989) Epidemiology of nocturnal asthma
Am J Med
(1988)- et al.
Regular inhaled beta-agonist treatment in bronchial asthma
Lancet
(1990) Inhaled corticosteroids—their present and future role in the management of asthma
J Allergy Clin Immunol
(1988)- et al.
The effects of high dose inhaled beclomethasone dipropionate on glucose and lipid profiles in normal and diet controlled diabetic subjects
Respir Med
(1989) - et al.
Screening for hypothalamopituitary-adrenal axis suppression in asthmatics taking high dose inhaled corticosteroids
Respir Med
(1991) - et al.
Bioequivalent doses of budesonide and prednisone in moderate and severe asthma
J Allergy Clin Immunol
(1989) - et al.
Control of asthma by aerosols
N Engl J Med
(1986) - et al.
European audit of asthma therapy
Chest
(1986) United States audit of asthma therapy
Chest
(1986)
The management of chronic asthma with daily nebulized beta2 therapy
J Allergy Clin Immunol
Use of anti-asthma drugs in New Zealand
Thorax
Actual usage of medical facilities by asthmatics in two French rural settings: a preliminary study
Eur Respir J
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Treatment
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2001, Revista Clinica EspanolaConsequences of long-term inflammation: The natural history of asthma
2000, Clinics in Chest MedicineCitation Excerpt :There are relatively few long-term studies of the effects of treatment on the natural history of asthma and the changes in lung function over time. Shorter-term studies show that effective anti-inflammatory treatment is associated with improved lung function, 9,34 reduced airway responsiveness, 7,28 fewer exacerbations, 43,57 and reduced mortality.17 The effect of treatment on the likelihood of remission is not known.
Undertreatment in a nonselected population of adult patients with asthma
1996, Journal of Allergy and Clinical ImmunologyPharmacological Management of Acute and Chronic Bronchial Asthma
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The study was funded by the Medical Research Council of New Zealand, with supplementary funding by Astra (Pharmaco) NZ Ltd and Fisons (NZ).
Manuscript received February 13; revision accepted May 18.