Clinical Question: Does continuous ...

Clinical Question: Does continuous therapy with anti-inflammatory medicines improve outcomes for patients with mild persistent asthma?

Setting: Outpatient (any)

application of mind Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: After an active run-in period, adults with mild persistent asthma (i.e., self-treatment with beta agonist more than sum of two units days per week, nighttime awakenings related to asthma more than couple days per month, or variability in the peak expiratory run of 20 to 30 percent) were randomized to receive 200 mcg of inhaled budesonide (Pulmicort) twice daily, 20 mg of oral zafirlukast (Accolate) twice daily, or matching placebo. All clumps could use rescue therapy with budesonide as distressed according to a symptom guide, as well as inhaled albuterol (Ventolin). They were followed for single year with a variety of symptom scores and physiologic measures. Of 225 patients, 199 complet the study

After single year, patients in the placebo arrange (intermittent therapy only) performed slightly worse forward a number of outcome measures, as it is as exhaled nitric oxide flats and the percentage of eosinophils in the sputum There was no difference regarding the primary consequence of morning peak expiratory melt no clinically significant difference in the number of courses of budesonide or asthma ascendency scores (0.1 to 0.2 upon a six-point scale), and no difference in quality-of-life scores.

Bottom Line: Intermittent therapy, as measured through patient-oriented, clinical outcomes, is as effective as continuous therapy with oral zafirlukast or inhaled budesonide for patients with extremely mild but persistent asthma. It is important to note that these patients had a clear plan of action for when symptoms flared up: Begin inhaled budesonide in the "yellow zone" when symptoms initially worsen, and add prednisone (05 mg by kg) if symptoms enter the "r zone" when breathlessness is current at rest or with activities of daily living. (Level of Evidence: 1b)

consideration Reference: Boushey HA, et al., and the National Heart, Lung and posterity Institute's Asthma Clinical Research Network. Daily versus as-needed corticosteroids for mild persistent asthma. N Engl J M April 14 2005;352: 1519-28

Used with permission from Ebell M Intermittent = continuous therapy for mild persistent asthma. Accessed online June 1 2005 at: http://www.InfoPOEMs.com.

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