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Corticosteroids for Mild Asthma Can Be Stepped-Down

Changes in treatment regimen allow corticosteroid dose to be reduced without treatment failure

WEDNESDAY, May 16 (HealthDay News) -- Patients with mild, persistent asthma that is well controlled can step down their inhaled corticosteroids and use a beclomethasone/albuterol inhaler as needed without risking treatment failure, according to two reports in the May 17 issue of the New England Journal of Medicine.

In the first study, Janet Holbrook, Ph.D., of Johns Hopkins University in Baltimore, and members of the American Lung Association Asthma Clinical Research Centers conducted a randomized step-down study in 500 patients with asthma that was well controlled with twice-daily inhaled fluticasone, and found that once daily fluticasone with salmeterol was just as effective while reducing the total corticosteroid dose. Once-daily montelukast was associated with higher treatment failure.

In the second study, Leonardo Fabbri, M.D., of the Universita di Modena in Italy, and the BEST study group found in a six-month, randomized, double-blind study that patients with mild asthma could use a beclomethasone/albuterol inhaler as needed and achieve the same effectiveness as regular use of beclomethasone while reducing the cumulative dose of inhaled corticosteroid.

A discussion of three treatment options for mild persistent asthma is presented in an accompanying Clinical Decisions interactive article, a new forum designed to understand the decisions physicians make everyday at the bedside and in the office. Readers are encouraged to participate online by voting for a treatment option and, if they like, to comment on their decision.

Financial disclosures are included with each article.

Abstract - Holbrook
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Abstract - Fabbri
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