VIEWS & REVIEWS

How earlyshould inhaledcorticosteroids be started in asthma?

It is reasonable to start inhaled corticosteroidtherapy in patients with asthma who require dailyinhaled ~-agonist therapy, who use one or morecani sters of a ~-agonisl per month, or who experiencenocturnal symptoms, say Drs Robert Tarpy and DavidCenter from the US. I

However, as yet , they do not prescribe inhaledcorticosteroids at the first diagnosis of asthma inevery patient. Such an approach has been suggestedby Dr Olof Selroos and colleagues, from Finland, withthe aim of providing the grea test treatment benefit andpossibly preventing the development of chronicreversible airway obsuu ction.!

Better-results in early <&ease?Results of a study by Dr Selroos and colleagues

showed that patien ts with mild to moderate asthmawho had a duration of symptoms of < 6 month s hadsignificantly greater impro vements in FEV I and peakexpiratory flow rate after 2 years' treatment withinhaled budesonide ('Turbuhaler' ], compared withpati ents with a longer duration of disease. The studywas unblinded and was not placebo-controlled.

Drs Tarpy and Center point out that most patient sdiagnosed with asthma only rarel y wheeze, and whenthey do it is in respon se to well-recognised stimuli,and never have progression of their disease to thepoint of daily symptoms or fixed airflow obstruc tion.I

However, they add that greater use of inhaledcorticosteroids in patients with mild asthma couldprevent the progression of disease to the point ofhospitalisation , thus reducing costs associated wit hthe disease. This issue requires further investigati on,as doe s the issue of potential long-term adverseeffects of inhaled corticosteroid therapy. For now,they suggest that the use of such therapy in patientswith mild asthma should be evaluated on anindividual basis.1. Tarpy R.et 01. When sbouJd inhaled cortico6teroids be started for aslhrna?Olest 108; 1188-1190. Nov 1m 2, Sclroos D. e!.01. Effect of early vs lalr:in~eotion with inhaled eorticosttsoids in ..thma. a.w.10&: 1228 -1234 , Nov1995 •••".,..

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