New study could change treatment for asthma

Most doctors tell asthma patients to stick to a regimen when taking medicine that helps control this disease. Asthma is a chronic and sometimes life-threatening lung disease that affects people around the world. There is no cure, but there are treatments. And now, global treatment guidelines for asthma could change as a result of a study led by a researcher at the University of Texas Medical Branch.

Most adults who have mild or moderate asthma are told to use their inhalers twice daily, even if they don't have symptoms. The medicine in those compressed-air inhalers are corticosteroids, which open a person's airways and decrease mucus so it's easier to breathe. Inhaled corticosteroids are the most common and the most effective form of therapy for asthma sufferers.

In an asthma attack, the airways of the lungs become inflamed and swollen. That can be triggered by a wide range of factors, some genetic, some environmental. Dust, air pollution or smoke can set off an asthma attack. Falling autumn leaves and other seasonal changes that put fine debris in the air can also trigger an attack.

Frank Grizzaffi knows this routine well. “There was a regime that I was supposed to follow, it was two puffs in the morning and two puffs in the evening,” Grizzaffi said.

That was before Grizzaffi participated in a study that involved ten academic centers and more than 300 adults with mild to moderate asthma.

Doctors evaluated the patients and determined the lowest possible dose of medication that would control their asthma. Dr. William Calhoun led the study.

“The amount of corticosteroid that a patient received during the trial was dependent upon the amount of symptoms they had. When they had fewer symptoms they got less steroid when they had more symptoms they got more steroid,” Calhoun said.

After adjusting medication, doctors looked at three different ways of treating the patients.

One group received their adjusted dose of steroids and took them as usual. Another group had their steroid levels adjusted after taking sophisticated breath tests for asthma and a third group was told to use inhalers only when their symptoms flared up.

What the researchers found was that this last group did just as well as the other two. The major difference was the last group used only half as much medication.

“The symptoms-based arm (group) resulted in a reduced use of inhaled corticosteroids, a 50 percent reduction. It also resulted in a reduction in exacerbation in the autumn, a time when exacerbation are typically high and it also resulted in a reduction in absenteeism from school or work,” Calhoun said.

Under his doctor's care, Frank Grizzaffi no longer follows his old regimen. “I’ll take one puff in the morning and that usually takes care of it the rest of the day. I feel great, I feel really good,” Grizzaffi said.

Dr. Calhoun advises patients with mild to moderate asthma to check with their doctors to see if this strategy might work for them. The study was published in The Journal of the American Medical Association.