Reduced Asthma Treatment Works
May 22, 2003 -- Inhaled steroids are the most effective asthma treatment, but their long-term use at high doses may result in bone loss, cataracts, and other side effects. But now new research shows that the dose of inhaled steroids can be safely lowered once asthma is under control -- even for patients with severe asthma.
"It is becoming clearer that most patients, even those with severe, chronic disease, will get maximum benefits from low to medium doses of inhaled steroids," researcher Neil C. Thomson, MD, tells WebMD. "In this study, we were able to show that asthma flare ups could be controlled at these dosages in patients with chronic asthma."
Among 259 patients with long-term stable asthma, the researchers found that they could drop the dose of inhaled steroids up to half without worsening asthma symptoms. After one year, the patients whose doses were lowered fared as well as those who remained on high-dose inhaled steroids.
The step-down approach followed by the researchers involved cutting the inhaled steroid dose in half and then increasing it gradually if asthma symptoms worsened. By the end of the study, the inhaled steroid dose averaged 25% lower in the step-down group than among those whose asthma medication was not altered. Over the course of a year, both groups took similar amounts of oral steroids, which are used to treat asthma attacks.
The findings are published in the May 24 issue of the British Medical Journal.
Asthma specialist William Anderson, MD, says the study confirms that asthma specialists -- who already commonly use the step-down approach -- are doing the right thing. He adds the approach used in the U.S. is in line with the reduced doses used in this study.
"The patients in this study started out on much higher doses than are generally given to the average patient," Anderson tells WebMD. "Patients with severe asthma may initially need to be on these high doses, and this research shows that stepping down dosages works and is appropriate even in these patients."
Anderson, a spokesman for the American Academy of Allergy, Asthma and Immunology, says all asthma patients on high-dose steroids should be followed closely with an eye toward reducing them to a medium or even low daily dose. He adds that the biggest problem in asthma treatment is not that patients are receiving too much treatment, but too little.
"Not enough people with asthma are on inhaled steroids or receiving any treatment at all," he says. "Asthma is a very treatable condition, and too many people are suffering when they don't have to be."
"It is becoming clearer that most patients, even those with severe, chronic disease, will get maximum benefits from low to medium doses of inhaled steroids," researcher Neil C. Thomson, MD, tells WebMD. "In this study, we were able to show that asthma flare ups could be controlled at these dosages in patients with chronic asthma."
Among 259 patients with long-term stable asthma, the researchers found that they could drop the dose of inhaled steroids up to half without worsening asthma symptoms. After one year, the patients whose doses were lowered fared as well as those who remained on high-dose inhaled steroids.
The step-down approach followed by the researchers involved cutting the inhaled steroid dose in half and then increasing it gradually if asthma symptoms worsened. By the end of the study, the inhaled steroid dose averaged 25% lower in the step-down group than among those whose asthma medication was not altered. Over the course of a year, both groups took similar amounts of oral steroids, which are used to treat asthma attacks.
The findings are published in the May 24 issue of the British Medical Journal.
Asthma specialist William Anderson, MD, says the study confirms that asthma specialists -- who already commonly use the step-down approach -- are doing the right thing. He adds the approach used in the U.S. is in line with the reduced doses used in this study.
"The patients in this study started out on much higher doses than are generally given to the average patient," Anderson tells WebMD. "Patients with severe asthma may initially need to be on these high doses, and this research shows that stepping down dosages works and is appropriate even in these patients."
Anderson, a spokesman for the American Academy of Allergy, Asthma and Immunology, says all asthma patients on high-dose steroids should be followed closely with an eye toward reducing them to a medium or even low daily dose. He adds that the biggest problem in asthma treatment is not that patients are receiving too much treatment, but too little.
"Not enough people with asthma are on inhaled steroids or receiving any treatment at all," he says. "Asthma is a very treatable condition, and too many people are suffering when they don't have to be."