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National Jewish Researchers Find Regular Use of Inhaled Beta-Agonist is

National Jewish Health

People who use beta-agonists on a regular schedule to control mild asthma symptoms receive no greater benefit than people who use beta-agonists only to control asthma symptoms as-needed, according to an article published today in the New England Journal of Medicine.

"Fixed-schedule use of the beta-agonist was no better than if the patient used it when they needed it," explains Richard Martin, M.D., a physician at National Jewish Center for Immunology and Respiratory Medicine and principal investigator of the NIH Asthma Clinical Research Network (ACRN) in Denver. In addition, patients who use a beta-agonist only as-needed realize some cost savings.

Researchers participating in this multi-center National Institutes of Health study also found that using beta-agonists regularly causes no adverse health effects, as had been thought.

"This study shows that if a patient with mild asthma needs to use their inhaler more frequently, the inhaler is not making the disease worse," Dr. Martin says. "Patients who use beta-agonists on a fixed schedule have a good response even after using the medication for several months."

The ACRN study followed 255 patients with mild asthma, ages 12 to 55, for 6 months. After a 6-week evaluation period, patients received the inhaled beta-agonist, albuterol, 2 puffs 4 times a day, or an identical-appearing placebo inhaler for 16 weeks. Patients in both groups were permitted to take additional albuterol, when needed for relief of asthma symptoms. During a final 4-week withdrawal period, all patients received only as-needed albuterol.

The study showed that even though the average use of albuterol was 5 times higher in the regular-use group than in the as-needed group, there were no significant differences between the two groups in measures of lung function, asthma symptoms, or quality of life that could be attributed to the treatment. But people with mild asthma who continue to expand their use of a beta-agonist may have some cause for concern. "Increased inhaler use likely is a sign of worsening asthma and signals the need for a patient to contact their physician," Dr. Martin says.

Beta-agonists provide relief of asthma symptoms by relaxing airway smooth muscle, but do not treat the underlying inflammation that produces the symptoms.

Asthma is a chronic lung disease that affects more than 13 million Americans. The frequency, severity of illness, and death rate from the disease all have been increasing steadily for more than a decade. Asthma also is a major cause of lost wages and school absenteeism, resulting in estimated annual health care costs of more than $4.6 billion. The National Heart, Lung, and Blood Institute's Communications Office contributed to this release.

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