Synthetic corticosteroids mimic the steroid hormone cortisol and reduce inflammation in the airways. However, the drug targets a type of inflammation that occurs in far fewer patients than previously thought. This emerges from a recent edition of the New England Journal of Medicine (19459025). In patients over 12 years of age with mild, persistent asthma, more than half was as good or better than placebo as a steroid inhaler.
"" We suggest that it is time to rethink the recommended standard of care for these milder patients, "says Stephen Lazarus, a pulmonologist at the University of California San Francisco and lead author of the study.
Since the early 1990s, the international guideline for treating patients with mild, persistent asthma was to use a low-dose steroid inhaler twice daily. The recommendation was mainly based on studies in people with severe asthma; The idea was that people with mild symptoms who used the steroid inhaler early on would later prevent damage to their airways.
But when the medications did not appear to reduce asthma attacks, the doctors accused the patients.
I attributed her poor asthma control to the fact that she did not take her medication," says Lazarus, "and it may be that many of them took their medication – they just did not work. "
Lazarus and his team examined about 300 patients with mild asthma. The vast majority – 73% – did not have type 2 inflammation, an inflammation characterized by high levels of eosinophilic white blood cells, which are thought to be much more common in asthma patients.
66% of these patients had just one inflammation as well, or better, on a placebo as on the steroidal inhaler mometasone with regard to urgent care visits, days when they had difficulty breathing or nights when they woke up because they could not breathe.
does mometasone, declined to comment on the study.
"We may give people steroids that are exposed to potential adverse effects and increased costs without significant clinical benefit," says Lazarus. While inhaled steroids are generally safe, there is a certain risk of bone loss, cataracts, glaucoma and skin thinning.
Bone atrophy has long been a concern of asthma patient Suzanne Leigh, who works in the UCSF media department.
"I am a white woman with a low BMI and a history of autoimmune disease, which exposes me to a high risk of osteoporosis," says Leigh.
Reading the study, Leigh says she was frustrated to learn that the $ 500 worth of asthma inhaler, which may increase her hip fracture risk in a few years, may not work.
"I do not know where I'm going from here." She says. "Do I continue the medication or do I stop – and end up in the emergency room?"
Lazarus suggests that she follow her doctor's current recommendation. While the study suggests that the guidelines for the treatment of mild asthma may eventually shift, Lazarus requires a more comprehensive and lengthy study before major clinical changes are made.
This leads to visits to the emergency room and they react when they are treated with inhaled steroids. Then it somehow does not matter what the lab test shows, "he says." If they have a true clinical response, this is probably an appropriate treatment regimen. "
In general, however, there is no magic lab test that tells which asthma patients Speakers who have won and who have won out.
"I would say if you have people who take inhaled steroids and do not respond, the answer is not necessarily to just keep increasing the dose," he says. "but to ask if there is such an alternative. "