Is Less Asthma Medicine in Your Future?

Asthma control is possible for most people who have asthma. That means you can expect to live an active life without being bothered by daily or nightly asthma symptoms.

The catch is that you generally will need to be on a long-term controller medication to achieve that. The usual prescription for an asthma medicine used as a controller medicine until now has been a twice daily dosage—once in the morning and again at night.

However, a new study by the American Lung Association that was just published in New England Journal of Medicine on May 17, suggests that people who are classified as having "mild persistent asthma" may be able to achieve adequate asthma symptom control with only a once daily dose of controller medicine.

Mild persistent asthma applies if you have asthma symptoms (without medicine) more than twice a week, but not as often as daily, are occasionally awakened at night with asthma symptoms, and sometimes have asthma attacks.

The study looked at 500 asthma patients who had already achieved control with twice daily fluticasone (Flovent®). Patients were divided into 3 groups:

• 169 patients continued taking twice daily fluticasone
• 166 patients switched to montelukast (Singulair®) 5 to 10 mg at night
• 165 patients switched to a combination drug called Advair®,which mixes fluticasone with salmeterol

Patients continued with this treatment plan for 16 weeks, and researchers looked at the rate of what they called "treatment failure," which meant that the patient experienced one of the following during the study period:

• needed to seek urgent medical care or hospitalization for an asthma flare-up
• had injected steroids to treat asthma flare-up or added inhaled steroid prescription
• had decrease in the morning peak flow rate to more than 35% below the patient's personal best prior to the study on 2 days in a row
• used 10 puffs or more per day of rescue medicine for 2 days in a row
• refused to continue in study due to dissatisfaction with treatment
• physician needed to change medication regime due to safety concerns

What they found as a result of the study is that almost a third (30%) of the patients switched to Montelukast had treatment failure. Only about 2 out of every 10 patients taking either the twice daily fluticasone or the once daily combination drug (Advair) had treatment failure.

So researchers have concluded that decreasing to a once daily controller medicine that contains fluticasone seems to have no negative effect on asthma control in patients who have mild persistent asthma.

Why This Study Is Important

Standard asthma treatment guidelines recommend inhaled steroids as the best treatment for all kinds of asthma. When asthma control is achieved, these guidelines also recommend a stepping down of treatment to limit side effects. One way to step down is to take medicine less often. Most studies up until now have focused on the effects of step down on those with moderate or severe asthma, however.