Learning from long-term studies with inhaled steroids in asthma

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 persistence.


Asthma classification and treatment for each stage (click to enlarge the image).

"Rule of 2s” is used to determine level of control. If any of these are positive, consider a daily controller medication:

- daytime symptoms more than 2 days/wk
- rescue β2 -agonist use more than 2 times per week
- nighttime symptoms more than 2 nights/mo
- more than 2 asthma exacerbations per year
- more than 2 rescue β2-agonist canisters/yr

Much knowledge about the long-term benefits of ICSs in persistent asthma stems from studies of the ICS budesonide.

The 3-year double-blind phase of the inhaled Steroid Treatment As Regular Therapy study indicated that early ICS treatment reduces risk of severe exacerbations by 44% in adults and children with ICS-naive asthma

In the Childhood Asthma Management Program (CAMP) study, ICS treatment did not alter the progression of asthma.

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).

References:
Inhaled corticosteroid therapy for patients with persistent asthma: Learnings from studies of inhaled budesonide. Chipps, Bradley E. Allergy and Asthma Proceedings, Volume 30, Number 3, May/June 2009 , pp. 217-228(12).
Reference for rule of 2's: Audio: Asthma, noon conference. Muthiah Pugazhenthi. Podcasting Project for the UT Internal Medicine Residency Program, 12/2006.
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