Author: Chipps, Bradley E.¹

Source: Allergy and Asthma Proceedings, Volume 30, Number 3, May-June 2009 , pp. 217-228(12)

Publisher: OceanSide Publications, Inc

Abstract:

Inhaled corticosteroids (ICSs) are recommended for patients with asthma who use a short-acting β₂-adrenergic agonist more than twice weekly—a key indicator of disease persistency. Much knowledge about the long-term benefits of ICSs in persistent asthma stems from studies of the ICS budesonide, which have shaped current asthma guidelines. Results of the 3-year double-blind phase of the inhaled Steroid Treatment As Regular Therapy study indicated that early ICS treatment improves impairment and reduces future risk of severe exacerbations by 44% in adults and children with ICS-naive, recent-onset persistent asthma. These benefits were maintained or improved during the 2-year open-label phase; however, the benefit of very early versus later introduction of ICS treatment on pulmonary function could not be established. Similarly, in the Childhood Asthma Management Program (CAMP) study, ICS treatment did not alter the progression of asthma. The CAMP study, however, highlighted the need for continued daily ICS treatment, thus providing evidence for the new asthma guidelines' focus on improving asthma control versus altering natural history. In patients not controlled on daily ICSs alone, the Oxis and Pulmicort Turbuhaler in the Management of Asthma (OPTIMA) and Formoterol And Corticosteroids Establishing Therapy (FACET) studies of budesonide showed benefit of ICS combination therapy with a long-acting beta₂-adrenergic agonist (LABA). Taken together, these studies show the efficacy of daily ICS therapy in patients with mild to moderate persistent asthma, support the benefits of initiating ICSs early and continuing treatment, and underscore the need to increase to ICS/LABA in those uncontrolled on ICS alone.

Keywords: Asthma control; budesonide; combination therapy; formoterol; inhaled corticosteroids; long-acting beta2-adrenergic agonist; mild persistent asthma; single-controller therapy

Document Type: Research article

DOI: 10.2500/aap.2009.30.3201

Affiliations: 1: Capital Allergy and Respiratory Disease Center, Sacramento, California, USA. bchipps@capitalallergy.com

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• Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.
  
  The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.
  
  Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.
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