From the Guidelines
For mild asthma, inhaled corticosteroids (ICS) are recommended as the first-line treatment, with the preferred approach being low-dose ICS-formoterol as needed, such as budesonide-formoterol (Symbicort) 160/4.5 mcg, 1 inhalation when symptoms occur, as supported by the most recent guidelines 1. The use of ICS in mild asthma is based on their ability to reduce airway inflammation, which is the underlying cause of asthma symptoms, as noted in the expert panel report 3 (EPR-3) guidelines 1. Some key points to consider when prescribing ICS for mild asthma include:
- The importance of proper inhaler technique to ensure effective delivery of the medication
- The need to rinse the mouth after ICS use to prevent oral thrush
- Regular follow-up to assess symptom control and adjust treatment as needed
- The consideration of alternative treatments, such as leukotriene receptor antagonists, for patients who cannot tolerate ICS or have contraindications to their use, as discussed in the medical therapy for asthma updates from the NAEPP guidelines 1. It's also important to note that combination therapy with ICS and long-acting beta agonists (LABAs) may be considered for patients with moderate persistent asthma, as it has been shown to lead to clinically meaningful improvements in lung function and symptoms, as supported by numerous studies 1. However, for mild asthma, the focus should be on using the lowest effective dose of ICS to control symptoms and minimize the risk of side effects, as recommended by the guidelines 1.
From the Research
Steroid Recommendation for Mild Asthma
- The use of inhaled corticosteroids (ICS) is a common treatment approach for mild asthma, with studies suggesting that low-dose ICS can be effective in controlling symptoms and reducing airway inflammation 2, 3.
- A study comparing the effects of low-dose fluticasone propionate (250 microg/day) with a placebo found that the treatment group showed significant improvements in airway responsiveness and reductions in sputum eosinophil counts 2.
- Another study found that 200 μg/day of fluticasone propionate was as effective as 1000 μg/day in improving asthma control, airway inflammation, lung function, and airway hyperresponsiveness in adults with mild or moderate asthma 3.
- The combination of ICS and long-acting beta2-agonists (LABAs) has also been shown to be effective in treating asthma, with studies suggesting that this combination can be more efficacious than adding a short-acting beta2-agonist or an antileukotriene 4, 5.
- The use of a single inhaler containing both ICS and LABA can simplify treatment regimens and improve adherence, although more research is needed to confirm this 4, 5.
Treatment Options
- Fluticasone propionate is a commonly used ICS, available in various doses and formulations, including combination inhalers with LABAs such as formoterol 2, 5, 3.
- Beclomethasone dipropionate is another ICS that has been compared with fluticasone propionate in clinical trials, with fluticasone propionate showing greater efficacy at lower doses 6.
- The choice of treatment should be individualized based on patient factors, such as symptom severity, lung function, and previous treatment response, as well as consideration of potential side effects and interactions 4, 6, 5.