Previous research has not established whether steroids could be effective in controlling mild asthma, mainly because people with moderate disease symptoms were included in earlier studies. Romain Pauwels from Ghent's University Hospital, Belgium, and colleagues did a randomised clinical trial in over 7200 patients age 5-66 years from 32 countries to assess the effects of the steroid budesonide in patients with mild asthma. Asthma onset had to be recent (within two years) and patients had not received previous treatment with steroids. They were randomly allocated to receive either inhaled budesonide or placebo once daily for 3 years in addition to their usual asthma medication.
44% fewer patients developed severe asthma attacks (emergency visits and hospitalisations) in the group given budesonide compared with those given placebo. Patients on budesonide were 40% less likely to require systemic corticosteroids and had more symptom-free days than patients given placebo. Budesonide also improved long-term lung function and was well tolerated; however the drug had a negative influence on growth for children under 11 years of age-3-year growth was reduced in the budesonide group by 1.34 cm compared with children given placebo.
Romain Pauwels comments: "Our study has shown that once-daily, low-dose budesonide decreases the risk of severe exacerbations and the need for systemic steroids in patients with mild persistent asthma, and that the drug improves their overall control of asthma. The benefits of this treatment outweigh the small effect on growth in children. Our results provide new evidence for recommendations in treatment guidelines about the use of inhaled steroids as early intervention in mild persistent asthma."
See Commentary (p 1066)
Contact: Professor Romain A Pauwels, Department of Respiratory Diseases, University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium;
T) 32-9-240-2611;
F) 32-9-240-2341;
E) romain.pauwels@rug.ac.be
Journal
The Lancet