Published/Last Reviewed: April 28, 2005
If you have asthma, your doctor has probably prescribed a daily schedule of medications to control the frequency of attacks and to stave off further lung damage. But if you are one of the many people with a mild persistent form of the disease, who find the daily rigors of taking asthma medication when you are not experiencing symptoms a hassle, you may be able to talk to your doctor about not taking all of them, and still effectively control your asthma.
In a study published on April 14, 2005 in The New England Journal of Medicine, researchers looked at the impact that not taking these drugs had on the frequency and severity of asthma attacks. Surprisingly, the results showed that not taking the daily medications might be a good strategy for people with mild persistent asthma who usually experience minor symptoms no more than 2 to 4 days a week that don't effect their daily activities.
"The purpose of our study was to ask: 'Do the experts have it right? Do they really need to take a medicine every day?'" said Homer Boushey, MD, professor of medicine at the University of California and past president of the American Thoracic Society.
There are two components of asthma: airway inflammation and bronchoconstriction, the tightening of the breathing tubes. For years, doctors believed that by taking medicines that treat both causes of asthma, one could better control their condition and limit the number of asthma attacks, severe wheezing, breathing difficulty and chest tightness. To treat these two symptoms, there are two types of asthma medications, controllers and relievers; anti-inflammatory drugs control the airway inflammation, preventing asthma attacks, and bronchodilators act quickly to open the airway and stop asthma attacks.
The most common form of reliever medications for asthma are beta agonists and inhaled corticosteroids. They work to relax the smooth muscles in the lung, making it easier to breathe. These drugs are only supposed to be used at the onset of an asthma attack.
"It's sort of a Band-aid," said Dr. Boushey, "It's not doing anything about the basic problem: the abnormal sensitivity of the airways or their inflammation. They can be lifesaving, but they're more for relief of attacks."
Controller medications, however, are long-term drugs that are supposed to be taken every day. They may include corticosteroids, long acting beta-agonists, theophylline or leukotriene inhibitors, all of which prevent the airway inflammation that leads to asthma attacks. Many people with mild asthma often do not take, or even purchase, their controller medications because their asthma isn't enough of a concern day-to-day to make the expense and bother of taking them every day worthwhile. These people tend to rely more heavily on reliever medications.
"Only 30 to 35 percent of people with asthma, who are prescribed an inhaled steroid renew it even one time even when they were told they should take it every day. They should be renewing it six to twelve times a year." said Dr. Boushey, "This might mean that people are taking the medication only when their symptoms flare up."
While most would think that forgoing the controller medications would adversely impact one's asthma, it had never been tested. In this study, 225 adults with mild persistent asthma were divided into three groups: one group received budesonide, a corticosteroid, to be taken as a reliever when needed, one group received a twice-daily dose of zafirlukast, a leukotriene-receptor antagonist, and the last group received placebo drugs. At the end of the year-long study, there was no significant difference in the morning peak expiratory flow (PEF), the amount of air you can exhale, or in the number of asthma attacks, all of which are measures of asthma control. The biggest difference was that those taking only reliever medicines had fewer symptom-free days.
Dr. Boushey recommends that those who think they have mild asthma first be sure they have a mild form of the condition. He warns that many people may have more severe asthma, but their controller medications are working so well that their asthma is effectively controlled. A careful history of symptoms and a simple test where you blow air into a spirometer, can tell you the severity of your asthma. If this test confirms that you have mild asthma, talk with your doctor about reassessing your treatment plan.
"The decision might be one that can be individualized," said Dr. Boushey, "We needn't make a rule that everybody with mild persistent asthma needs to take a treatment every day."