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Regular daily inhaled corticosteroids need not be initiated early in mild asthma.

Asthma is a chronic disease that is characterized by reversible airflow obstruction and airway inflammation. It affects millions worldwide. The severity of asthma can vary from individual to individual. In some it is very mild and they become symptomatic only when environmental factors triggers airway inflammation. In others it is severe enough to cause daily symptoms. The standard recommended treatment for asthma is a combination of inhaled bronchodilator (beta agonist) and inhaled steroid. The drug is started in a step up fashion depending on the severity; starting with low dose inhaled steroid and then increasing the dose and adding inhaled bronchodilator to strengthen the regimen.

The following discussion is for informational purpose only and not a treatment recommendation. Only your personal physician can decide on what therapy is appropriate to you.

Physicians generally prescribe medications to asthmatics based on international guidelines issued by GINA (Global Inititiate Against Asthma). While there is broad consensus regarding the treatment of moderate and severe asthma, there is some controversy in the treatment of mild asthma. Daily medication versus as and when needed medication for mild asthma is one of topics of consideration. The results of some of the recent trials conducted to study the usefulness of regular inhaled corticosteroids do not favor its use in MILD asthma on a daily basis. Though it provides benefits in the short term its long term usefulness in changing the natural progression of asthma is doubtful. Hence early initiation of inhaled steroids is not warranted if the asthma is mild and the patients get only episodic  intermittent symptoms. They can use inhaled steroids/bronchodilators as and when they become symptomatic. 

In this article we present you some of the conclusions derived from several asthma clinical studies including IMPACT (Improving Asthma Control Trial), START (Inhaled steroid therapy as a regular therapy in early asthma), PEAK (Prevention of early asthma in kids) for your consideration.

1. No significant differences were seen between the two groups (inhaled steroids vs placebo) in the proportion of episode free days, the number of exacerbations or lung function during the observation period.  (PEAK trial)
2. No statistically significant difference in clinical or functional variables were found between patients  given early or delayed inhaled steroid therapy after 10 year follow up (Haahtela et al)
3. At the end of the five year period the post bronchodilator forced vital capacity in one second (a measure of lung function) decreased irrespective of assigned treatment. There is no significant advantage in starting early treatment with inhaled steroids as people who were introduced late on inhaled steroids had similar lung function at the end (START trial)

Although daily inhaled steroids decreases airway inflammation, these benefits are lost once the steroid inhalation is stopped for even 48 hours. Hence there is no long term effect on the course of the disease process by using inhaled steroids daily. Based on the results mentioned above it may be inferred that regular inhaled steroids may not be needed for individuals with mild asthma. Physicians may be able to treat mild intermittent asthma with short intermittent courses on inhaled steroids/bronchodilators.

Reference

Current Opinion in Pulmonary Medicine: January 2011 - Volume 17 - Issue 1 - p 12–15 doi: 10.1097/MCP.0b013e3283410025