As-needed controller medication works in mild asthma in primary care

Published online: July 30, 2019

Daily use of inhaled corticosteroids (ICS) has been recommended for the treatment of persistent asthma for the past three decades. However, adherence to daily therapy is challenging for many patients and remains low (~50%), especially in the primary care setting. Several alternative, non-daily strategies for taking ICS have been studied in the past decade, given the ongoing obstacles for daily therapy. Symptom-based use of ICS is a patient-centered strategy in which patients do not take daily ICS but take their ICS together with the reliever (short-acting beta-agonist) when triggered by their symptoms. This strategy has been shown to provide asthma control and event rates comparable to daily ICS in rigorous controlled trials in highly selected study patients and has been recently added in the global asthma guideline. However, it has never been tested if it works in the real-world, primary care setting.

In the recently published article of The Journal of Allergy and Clinical Immunology: In Practice, Sumino and colleagues investigated whether symptom-based use of ICS works in the hands of community pediatricians in the real-world setting. The study included 206 African American children with mild asthma who were receiving care at the participating primary care pediatrician in St. Louis, MO. USA. Asthma outcomes at 12 months with symptom-based use of ICS were compared with that of daily ICS, and the treatment strategies were implemented by the children’s community primary care pediatricians.

This study found that symptom-based use of ICS among African-American children with well-controlled, mild asthma provided similar levels of asthma control, asthma-related events, and lung function compared to daily therapy with almost 1/4th of the ICS exposure. This patient-centered strategy can be considered as an alternative strategy for managing mild asthma in children in the primary care setting, especially in those who have concerns regarding ICS or difficulty in adhering to daily ICS therapy.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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