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September 12, 2012

Inhaled Corticosteroid Dose Adjustment in Mild Persistent Asthma

Author Affiliations

Author Affiliations: Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts (Dr O’Connor); and Departments of Medicine and Environmental Medicine, New York University, New York (Dr Reibman). Dr O’Connor is also Contributing Editor, JAMA.

JAMA. 2012;308(10):1036-1037. doi:10.1001/2012.jama.11405

Regular use of controller medications, such as inhaled corticosteroids (ICS), improves outcomes in patients with asthma. The importance of daily use of ICS is emphasized in asthma management guidelines.1 However, ensuring that patients with asthma adhere to daily use of ICS, even when asymptomatic, is a challenge. Therefore, clinicians spend substantial time and energy educating patients with asthma about the importance of daily use of ICS. The latter medications, however, do not lead to the immediate relief of asthma symptoms associated with short-acting rescue bronchodilators, such as albuterol, so patients often neglect to take ICS due to the incorrect perception that they do not help. This frequently observed pattern of poor adherence to daily use of ICS has led to the hypothesis that tying use of ICS to the as-needed use of a short-acting bronchodilator may lead to better asthma control for patients with relatively mild asthma. Combining use of ICS with as-needed short-acting bronchodilators may improve asthma control by increasing the patient's motivation to take ICS and by focusing ICS therapy on periods when symptoms of asthma (which vary over time due to environmental factors) are more prounounced. This as-needed ICS strategy could also potentially reduce costs and patient inconvenience by avoiding use of ICS when asthma is not bothersome.

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