Symptom-driven “rescue” use of a single inhaler containing beclomethasone plus albuterol was as effective at controlling mild persistent asthma as was regular twice-daily use of inhaled beclomethasone alone in a prospective, randomized study.
As-needed use of the combination inhaler led to significantly lower cumulative exposure to corticosteroids. In addition, “symptom-driven use of inhaled beclomethasone and albuterol may overcome one of the major problems in the treatment of chronic diseases such as asthma: poor compliance,” the investigators wrote.
Dr. Alberto Papi of the University of Ferrara (Italy) and colleagues compared outcomes with four different inhaler treatments in a 6-month study of 393 adults with mild persistent asthma who were treated at 25 centers in Europe in 2002–2004. The participants were randomly assigned to one of four treatment groups: as-needed combination therapy (250 mcg beclomethasone and 100 mcg albuterol in a single inhaler), regular twice daily combination therapy plus albuterol as needed, regular beclomethasone therapy (250 mcg twice daily) and albuterol as needed, or placebo twice daily plus albuterol as needed.
After 6 months, morning peak expiratory flow rate (primary outcome measure) did not differ significantly between the as-needed combination therapy group and the regular twice-daily beclomethasone or regular combination therapy groups, suggesting “mild persistent asthma may not require regular treatment with inhaled corticosteroids, but rather only as-needed use of an inhaled corticosteroid and an inhaled bronchodilator” (N. Engl. J. Med. 2007;356:2040–52). Chiesi Farmaceutici funded the study.