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.

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    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 morethan 35% below the patient's personal best prior to the study on 2 days in a row
    • used 10puffs 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.


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    But, since mild persistent asthma affects large numbers of people, this was an important group to investigate. Also, one of the most common problems with achieving asthma control is that asthma patients frequently do not take their asthma medicine as often as prescribed. Why?

    • Asthma medicine is expensive, so some people take less in an effort to save money.
    • Sometimes asthmatics forget to take their asthma medicine, especially when they're feeling good.
    • Or, an asthma patient might be uncomfortable using an inhaler in public, so the dose is skipped.
    • Patients don't like side effects caused by the medicine.

    There may be other reasons as well, but those are some of the most common. So, if mild persistent asthma patients could take medicine less often and still achieve satisfactory asthma control, it could increase compliance with the treatment regime.


    Also, it's important to note that although Montelukast did not perform quite as well in this study, it still provided adequate asthma control in most patients.


    Ultimately, you and your doctor must balance convenience, price, effects, and personal preference to come up with the best asthma treatment plan for you. So be sure to keep the lines of communication open with your doctor!

Published On: May 21, 2007