If you're among the 15% of all asthmatics who take high dosages of inhaled steroids, you may not need as much medicine as you think to keep your disease in check.
A Scoftish study shows that patients with chronic, severe asthma can sharply reduce their dosages of inhaled steroids (to cut the risk of side effects) and still keep their condition under control.
The study was the first carefully controlled trial to show that this "step-down" approach works in chronic, severe cases of asthma.
Inhaled steroids are the recommended treatment for chronic asthma, but they are accompanied by a number of side effects, including weakened bones and eye problems, such as cataracts and glaucoma. For these reasons, doctors prefer to keep the dosage at a minimum.
The study included 259 adult asthma patients with symptoms severe enough to require aflayerage of 7,400 micrograms per day of beclomethasone, or equivalent amounts of other steroids.
For the study, 130 patients began taking half of their previous dosage, while 129 continued their old dosage. As is common in such controlled studies, none of the patients were told how much they were taking.
After one year, results were as good for the reduced-dosage patients as they were for the higher-dosage patients, according to Dr. Neil C. Thomson, professor of respiratory medicine at the University of Glasgow, and leader of the study.
DOCTORS SHOULD FOLLOW UP ON TREATMENT
"The study is a welcome reminder that doctors treating asthma patients should look toward reducing steroid dosage," says Dr. John J. Costa, assistant clinical professor of medicine at Harvard Medical School in Boston, and a spokesman for the American Academy of Allergy, Asthma & Immunology (AAAAI).
Often, asthma patients go to their doctors when the disease flares up, and higher doses are prescribed to bring things back to normal, he says. "The importance of this is to remind practitioners that often they see asthmatics and decide that a certain amount of medicine is needed to address what is going on at that moment. It may not be the amount of medicine needed when the patient is not in the middle of a flare-up," Costa says. "The doctor should follow up to see if it is possible to reduce the dosage."