8 INTERNATIONAL RESEARCH & OPINION

Early use of inhaled corticosteroids is beneficial in asthma

Initiation of regular treatment with inhaled cortico­steroids, compared with theophylline, in the year following the first ambulatory treatment for asthma reduces the incidence of hospitalisation in patients with asthma, report researchers from Canada.!

In this case-control study, 303 cases and 2636 controls were identified from a cohort of 13 563 newly treated patients with asthma. * The cases were patients who had been admitted to hospital for asthma within 12 months of starting treatment with inhaled corticosteroids or theophy lline. * * Two to 10 matched controls per case were selected; these patients had also been receiving inhaled corticosteroids or theophylline but were not admitted to hospital. Both cases and controls had started treatment with inhaled corticosteroids or theophylline in the year after they first received ambulatory treat­ment for asthma.

Hospitalisation less likely Odds ratios were calculated for the likelihood of

hospitalisation for recipients of inhaled corticosteroids, compared with patients receiving regular theophylline. The adjusted odds ratios for regular and irregular users of inhaled corticosteroids were 0.6 (95% CI 0.4-1.0) and 0.9 (95% CI 0.3-2.7), respectively, among patients receiving initial therapy, and 0.2 (95%

CI 0.1-0.5) and 1.0 (95% CI 0.3-3.7), respectively, among patients receiving subsequent therapy.

The researchers conclude that regular treatment with inhaled corticosteroids, compared with theophylline, can reduce the risk of being hospitalised for asthma during the first year of treatment, and that early treatment with inhaled corticosteroids may prevent aggravation leading to more severe and chronic asthma. They add that the study results suggest that 'inhaled corticosteroids need to be taken regularly, as recommended in the current guidelines, to obtain their beneficial effect'.

Results not surprising Drs Tari Haahtela and Tuno Klaukka from Helsinki,

Finland, comment that the reduction in the risk of hospitalisation seen in the above-mentioned study is 'a dramatic result, albeit not so surprising'.2

Drs Haahtela and Klaukka say that regular use of inhaled corticosteroids 'prevents exacerbations of asthma, fatal and near fatal episodes of asthma, and accelerated loss of lung function'. They believe that although there is a lack of evidence to show any change to the natural course of asthma resulting from use of inhaled corticosteroids, 'their invaluable short term effects justify their introduction as soon as the diagnosis of asthma is established' . * The study was supponed in pan by Boehringer Ingelheim Canada and Zeneca Canada. ** The two treatments were also classified as being used regularly or irregularly, and as initial therapy iJtreatment was initiated before the third prescription dispensedfor asthma or as subsequent therapy if initiated at or after the third prescription.

PharmacoEconomics & OuIr:omes News 13 Feb 1999 No. 199

1. Blais L. et al. First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma. Thorax 53: 1025-1029, [)e.

1998 2. Haahtela T. et al. Societal and health care benefits of early use of inhaled steroids. Thorax 53: 1005-1006, Dec 1998 _'"

1173-5503199/0199-0008/$01.00° Adi. International Limited 1999. All right. resen