New-onset mild asthma III: a sequel to 2 'Oscar winners'.

摘要

Haahtela et al have performed a remarkable 3-part experi ment in patients with new-onset, mild asthma that has now extended over a period of 13 years of follow-up. These investiga tors originally randomized 103 patients with new-onset, mild asthma to either budesonide or terbutaline treatment for 2 years. Patients treated with the inhaled corticosteroid (ICS) had better symptom, lung function, and bronchial hyperresponsiveness out comes. They then performed a crossover study in a subset of these patients for a third year. Switching from a high to a lower dose of ICS was generally effective in maintaining stable asthma symp toms, lung function, and bronchial hyperresponsiveness, but patients switched from ICS to placebo did poorly. In patients initially on the short-acting inhaled beta_2-agomst, beginning an ICS resulted in improved asthma outcomes but possibly not as good an improvement as those begun on ICS initially. The authors suggested that delayed initiation of ICS might lead to an impaired response. Haahtela et al have most recently re-evaluated 90 of the original 103 patients (reported in this issue of the Journal). Treatment during the 13-year interval between the initial study and this re-evaluation was not controlled-that is, this was a real-life follow-up. At this re-evaluation, these patients would generally be classified, according to the Expert Panel Report 3, as well controlled. However, they still had exacerbations requiring hospitalization, and those patients requiring hospitali-zations had a greater loss of lung function over time. Finally, there were subtle indications that the patients randomized to early ICS treatment in the initial study had better outcomes than those receiving the short-acting inhaled beta_2-agonist.