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| |  Inhaled Steroid Plus Oral Steroid Lowers Asthma Relapse Rate CHICAGO, IL -- June 8, 1999 -- Using an inhaler with steroids in addition to oral steroid medication helps to prevent relapse of an asthma attack better than using the oral medication alone, according to an article in tomorrow’s issue of The Journal of the American Medical Association. Brian Rowe, M.D., M.Sc., of the University of Alberta in Edmonton, AB., and colleagues studied 188 patients aged 16 to 60 years old who were seen in a community teaching hospital emergency department (ED) in Canada between November 1995 and September 1997 for acute asthma attacks. The researchers wanted to determine if adding an inhaled corticosteroid (ICS, anti-inflammatory medication that prevents and reduces swelling inside the airways and decreases the amount of mucus in the lungs) known as budesonide to oral corticosteroid (CS) treatment would reduce relapses of asthma in patients with acute asthma after being discharged from a hospital ED. All patients released from the hospital were prescribed 50 milligrams (mg) per day of oral prednisone for seven days. The patients also were randomly assigned to receive either 1,600 micrograms (µg) per day of inhaled budesonide (94 patients) or a placebo inhaler with no active therapeutic ingredient (94 patients) for 21 days. After 21 days, 12.8 percent (12 of 94 patients) of the budesonide patients experienced an asthma attack relapse, compared with 24.5 percent (23 of 94 patients) of the placebo patients, a 48 percent reduction in asthma relapses. The perceived quality of life, determined by scores on a questionnaire, was higher in the budesonide group than in the placebo group. Over the follow-up period, budesonide patients required fewer administrations of inhaled ß2-agonist medication, which is used for the immediate treatment of The researchers also report that there were no differences in lung function between the two groups, but the budesonide patients had higher self-assessed improvement of their asthma and fewer symptoms of cough, shortness of breath, night-time wakening and wheezing, compared with the placebo patients, the authors write. The authors believe this is an effective method of reducing relapses because for every nine patients treated with this regimen, one potential relapse can be prevented. "To our knowledge, this is the first study to examine whether adding an ICS enhances the effectiveness of oral CS in patients with acute asthma discharged from the ED," the authors write. "Our results demonstrate that the addition of high-dose budesonide [1,600 µg each day] reduces the rate of relapse, improves quality of life, and reduces ß2-agonist use after 21 days. "It appears that the full benefit of ICS is reached by 10 days, after which relapses are rare." According to information cited in the study, asthma affects approximately seven percent of adults in North America and asthma sufferers frequently come into hospital EDs with acute asthma. Because many of these patients are at increased risk for complications and even death, improved strategies to treat acute asthma and reduce relapses after ED visits are needed to improve patient quality of life and reduce societal costs associated with this disease. "By prescribing ICS, ED physicians are providing patients with evidenced-based therapy that they had not been receiving," the authors write. "By adopting a policy of initiating ICS therapy at the time of discharge, ED physicians have the opportunity to affect long term outcomes of patients with asthma." Although the results of this research shows the effectiveness of budesonide, the authors state further research is needed to determine the optimal dose, duration, delivery method for ICS, and whether oral CS can be safely reduced or eliminated in certain groups of asthmatics. Related Links: The Journal of the American Medical Association
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