[I read this and then thought I must have missed something. So I read
it again. I remember 12 years ago, thinking I could just stop taking my
inhaled corticosteroid and I'd be okay...and nearly died. No doctor has
ever said I had a "severe" form of asthma; all I know is that ever
since I started taking inhaled corticosteroids I've been able to have a
"normal life" of exercizing, not waking up two or three times a night
to take a shot of albuterol...I now sometimes go 3 or 4 months w/o ever
taking a single puff of albuterol!..What worries me a little here is
that there seems to be a semantic problem: how precise and uniform are
the terms "moderate" and "more severe" when it comes to asthma
diagnoses? I fear some of my brothers and sisters who wd do better
staying on inhaled corticosteroids will try to go off them, with very
unhappy results...And yes, maybe I do have a "more severe" asthmatic
syndrome and just haven't come to terms with it. Maybe. And how can one
dose on inhaled corticosteroids "intermittently"? Don't you need a few
days for them to kick in? And if they're working, shouldn't they be
tapered off? Maybe I'm just not "up" on the latest asthma
meds...Pulmicort has been a miracle drug for me, and I've always taken
it at half the recommended dose.-michael]

Los Angeles Times
April 14, 2005
THE NATION
Adults With Mild Asthma Can Limit Drugs, Study Says

By Thomas H. Maugh II, Times Staff Writer

About 4 million adult Americans with a mild form of asthma may not need
to take daily steroid doses, but instead can use the drug only as
needed to control symptoms, says a new study supported by the National
Institutes of Health.

The change would make drug use more convenient, minimize side effects
from the powerful drugs and possibly save the nation as much as $2
billion per year, the study concludes.

Its results do not apply to the 10 million adults with more severe
forms of the disease, but "for some adults with long-standing mild
persistent asthma, choosing not to take daily medications might be OK,"
said Dr. Elliott Israel of Brigham and Women's Hospital in Boston, the
co-leader of the study.

Israel noted that many such patients were routinely skipping the
medicine. About 30% of prescriptions for the daily steroids are
refilled, apparently because patients don't think it makes them feel
better. The findings, published today in the New England Journal of
Medicine, appear to validate that belief, he said.

The results are likely to change clinical practices in the management
of asthma, Dr. Leonardo M. Fabbri of the Universita degli Studi di
Modena e Reggio Emilia-Policlinico di Modena in Italy wrote in an
editorial accompanying the report. Intermittent dosing, he said,
"complies with the philosophy of achieving and maintaining control of
asthma with the least amount of medicine."

The study "shows that physicians can be less dogmatic in treating mild
asthma," not insisting that patients follow a carefully prescribed
regimen, added Dr. Jonathan Field, director of the New York University
Allergy and Asthma Clinic, who was not involved in the study.

Asthma is considered mild and persistent when individuals have acute
symptoms such as wheezing, coughing or chest tightness two to five
times a week or are awakened by asthma more than twice a month. Perhaps
a third of the 14 million U.S. adults and 6 million children with
asthma have this form. Children were not included in the study.

Treatment guidelines published in 1997 indicated that patients with
this form should use an inhaled steroid called budesonide (marketed as
Rhinocort) daily to control their disease and an inhaled bronchodilator
called albuterol to treat symptoms as they occurred. An alterative is
daily use of another drug, zafirlukast (marketed as Accolate).

Those guidelines were based on earlier studies that suggested daily use
of the drugs prevented long-term damage to the lungs. But closer
analysis of the studies indicated that many of the patients did not
have mild persistent asthma, said Dr. Homer A. Boushey of UC San
Francisco, the study's other co-leader.

In the new trial, 225 adults with confirmed mild persistent asthma were
given either daily budesonide, zafirlukast or a placebo, and allowed to
use a bronchodilator as needed. All patients were also given budesonide
and taught how to administer a 10-day course of the drug if they
suffered an outbreak of symptoms.

At the end of the year, "all three groups were far more alike than they
were different," Boushey said. Their lung functions were similar, they
had about the same frequency of severe attacks and they all showed
little or no evidence of lung damage.

Those taking budesonide reported about 24 more symptom-free days per
year, but they did not rate their quality of life higher than those
receiving zafirlukast or the placebo. "That's not too surprising,"
Boushey said, "because the symptoms of mild persistent asthma are, by
definition, mild."

Although the findings need to be confirmed by a larger study, he said,
"the guidelines should back off a little bit. Clearly, we've set the
bar too high for defining what people need every day."