Eh, I wouldn't get too excited.

The current guidlines say that if you are having symptoms more than 2-3
times per week you should be on daily meds. These guys are talking
about people who have the sx's 2-3 times per week but not daily - i.e
<7 times per week - basically asthmatics with symptoms between 3-6
times per week. That has got to be a small percentage of people. As
proof of this consider that the study was conducted at 6 centers over 2
years - all to recruit 255 people.

Indeed, it turns out that the asthmatics in this study were
exceptionally mild - with only two exacerbations per year even when off
of meds. As a reviewer* describes: "Moreover, since the population and
the design of the study by Boushey et al. differ from those of the two
previous studies supporting the need for regular treatment,3,4 the
results are not directly comparable. Although the lung function of the
subjects in the study by Boushey et al. was similar to that in the two
previous studies,3,4 only adults who were nonsmokers and who had a much
longer history of asthma and a lower incidence of exacerbations were
included (the other studies included smokers and children). Moreover,
the low percentage of eosinophils in the sputum and the low
concentration of nitric oxide in the exhaled air, both markers of the
severity of asthma, suggest that the patients enrolled by Boushey et
al. had a very mild form of persistent asthma.11,12 To complicate
matters, before randomization, all patients received about two weeks of
treatment with clinical doses of oral and inhaled corticosteroids and
zafirlukast. Thus, the initial intensive treatment and the
symptom-based plan to treat exacerbations may have had a carryover
effect, contributing to a reduction in asthma symptoms and in the
number and severity of exacerbations in the patients studied."

Also consider that some caution would be needed before adopting the
approach they suggest, using intermittent inhaled steroids with
exacerbations, since other research suggests that once an exacerbation
is underway adding or increasing inhaled steroids does little and oral
steroids are needed. (To be precise, 2 studies have shown that doubling
the dose is inneffective while one studiy showed that quadrupling it
is).

Over-all, their conclusions is reasonable: "It may be possible to treat
mild persistent asthma with short, intermittent courses of inhaled or
oral corticosteroids taken when symptoms worsen. Further studies are
required to determine whether this novel approach to treatment should
be recommended."

The reviewer concludes: "In the meantime, will the results of this
study change our clinical practice? They may indeed, since the option
of intermittent treatment with inhaled corticosteroids complies with
the philosophy of achieving and maintaining control of asthma with the
least amount of medication.1,2 This approach may be feasible in
patients with mild persistent asthma who have never received
corticosteroids, but such patients should have the same characteristics
as the patients in the study by Boushey et al., and the initial period
of intensive treatment should not be omitted. Patients should be
informed about the pros and cons of this strategy, including the
absence of a risk of major adverse events (severe exacerbations and
hospitalization) as well as the slightly increased risk of a greater
number of days with symptoms.

Intermittent treatment might also be offered to patients with mild
persistent asthma as an intermediate step to the withdrawal of
controller medication, if their disease is well controlled by regular
treatment with inhaled corticosteroids. The chief concern in
recommending this intermittent-treatment plan is that it requires a
very careful assessment of the severity of asthma, the risk being that
an underestimation of severity may be associated with undertreatment of
patients with more severe asthma.4

The paradigm that inhaled corticosteroids control asthma because they
suppress airway inflammation is appealing, but it is not really
supported by solid data, since other treatments that inhibit airway
inflammation are clinically ineffective.15 At the present time, the
treatment of asthma should still be based on patient-centered outcomes,
with the use of the least amount of medication required to achieve
control. With this approach, the severity of asthma will be reflected
by the amount of medication required to maintain control, and the
border between different levels of severity, and particularly between
mild intermittent and mild persistent asthma, may become blurred."

It was a small study carried on for a year in a group of patients in
which you expect  a low event rate (meaning that you need a lot of data
to find differences). I think that the reviewer has a point that this
may be useful now as a weaning step in well controlled asthmatics on
daily meds with virtually no sx's (OK twice a year) looking to cut down
further. For everyone else more study will be needed.

* Leonardo M. Fabbri, M.D. NEJM Volume 352:1589-1591

--
00doc

P.S. As a side note - Fox News?   That network is nothing but a blatant
propaganda network and its viewers have been shown to be misinformed.
If you haven't rented and watched a movie called "Outfoxed" you should
(really, everyone should - it is pretty amazing stuff). Why not try CNN
(or better yet the BBC)?

You might be able to do something about your mild asthma by finding
your hidden food allergies, with the help of a naturopathic doctor?

Brad_Chad62@yahoo.com