SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

9/13/04

Variability of symptoms in mild, persistent asthma

Summary
Background - In clinical trials of anti-asthma treatments, it is common to assess the baseline clinical status of patients during run-in period of a few weeks before implementing the intended treatment approaches. In mild asthmatics, findings in this run-in baseline assessment is considered to be representative of the "steady state" of the asthma in individual patients.

Summary - Zeiger et al of the Kaiser Permanente Medical Center in San Diego, CA and other institutions compared the symptom patterns and spirometric findings in 400 mild asthmatics (ages 15-85 years) during a) a two week run-in period before a medication study with b) similar parameters obtained during periodic evaluations over the previous year. In this group with a mean FEV-1 of 94% of predicted during the run-in period, medical intervention for acute asthma flares during the previous year occurred commonly (39% in office visits, 8% in Emergency Dept. visits and/or hospitalizations, 16% requiring at least one course of oral corticosteroids). Daily symptoms occurred in 12% during the month prior to the run-in period. The latter sub-group had more days/week with symptoms and fewer days without use of rescue meds during the subsequent run-in period, even though the mean FEV-1 was in the normal range (93% of predicted).

Conclusions - Patients with mild persistent asthma reported a substantial disease burden during the previous year. Such manifestations were of sufficient severity to warrant the recommendation that mild persistent asthma should be treated with daily controller therapy.

Reference
Respir Med 2004;98:898-905

Editor's Comments
These important findings should not come as a great surprise. Previous studies have shown that 25% of individuals with mild, persistent asthma treated with only prn rescue medication and a normal or only slightly decreased FEV-1 on evaluation will have at least one episode of acute asthma flare sufficient to necessitate urgent/emergent care during the subsequent year. Therefore, daily controller medication would be indicated in such individuals.

Another implication of the findings described above is that the status during a two week ran-in period may often not be representative of the "steady state" of the asthma status in those with mild persistent asthma.

 

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