Journal of Family Practice - PRN steroids are as good as—or better than—daily dosing for asthma
* Clinical question
Must inhaled corticosteroids be taken daily by patients with mild persistent asthma?
* Bottom line
No. For patients with mild persistent asthma, symptoms and exacerbations were controlled just as well using a combination of beclomethasone 250 mcg plus albutero1100 mcg as needed instead of daily. This approach reduced the amount of steroids given, and may result in better adherence as well.
Level of evidence
1b: Individual randomized controlled trial (with narrow confidence interval)
Study design
Randomized controlled trial (double-blinded)
Funding
Industry
Allocation
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Concealed
Setting
Outpatient (specialty)
Synopsis
For years we’ve been telling our patients with mild persistent asthma that they must take their corticosteroid inhaler daily, not as needed.
Is that really true?
In this study, 510 patients were given a 4-week course of beclomethasone dipropionate 250 mcg twice daily plus an albuterol inhaler to be used as needed. Those with good asthma control while using this regimen were then randomized to 1 of 4 groups: (1) continued beclomethasone 250 mcg twice daily plus albuterol as needed, (2) beclomethasone 250 mcg plus albuterol 100 mcg twice daily plus albuterol as needed, (3) albuterol as needed only, and (4) beclomethasone 250 mcg plus albuterol 100 mcg to be used as needed only. Patients received placebo inhalers to maintain masking, and outcomes were assessed by researchers masked to treatment assignment.
Of the 466 who started, 393 completed the 6-month study; dropouts were similar among the groups. Half the patients were women; mean age was 39 years.
Outcomes. A variety of physiologic measures of lung function found that the as-needed combination of steroid and beta-agonist:
* was more effective than albuterol alone
* was as effective as the traditional combination of daily steroid and as-needed beta-agonist.
The as-needed combination course resulted in:
* fewer exacerbations than the albuterol-only group (0.74 per year vs 1.63 per year; P
