No Superior Method of Adjusting Inhaled Steroids in Asthma

Time to treatment failure similar for physician-, biomarker-, symptom-based strategies

TUESDAY, Sept. 11 (HealthDay News) -- For adults with mild-to-moderate asthma controlled with inhaled corticosteroids, adjustment of corticosteroids based on biomarkers (exhaled nitric oxide) or symptoms does not improve the time to treatment failure compared with physician assessment-based adjustment, according to a study published in the Sept. 12 issue of the Journal of the American Medical Association.

William J. Calhoun, M.D., from the University of Texas Medical Branch in Galveston, and colleagues compared approaches for adjustment of inhaled corticosteroid therapy. A cohort of 342 adults with mild-to-moderate asthma controlled with low-dose corticosteroids were randomly assigned to physician assessment-based adjustment (114 assigned; 101 completed); biomarker-based adjustment (115 assigned; 92 completed); or symptom-based adjustment (113 assigned; 97 completed) for nine months.

The researchers observed no significant difference in the time to treatment failure between the groups. The nine-month Kaplan-Meier failure rates were 22, 20, and 15 percent for physician assessment-based adjustment, biomarker-based adjustment, and symptom-based adjustment, respectively. The hazard ratios for time to first treatment failure with physician assessment-based adjustment versus biomarker-based adjustment and symptom-based adjustment were 1.2 (95 percent confidence interval [CI], 0.6 to 2.3) and 1.6 (95 percent CI, 0.8 to 3.3), respectively.

"Among adults with mild-to-moderate persistent asthma controlled with low-dose inhaled corticosteroid therapy, the use of either biomarker-based or symptom-based adjustment of inhaled corticosteroids was not superior to physician assessment-based adjustment of inhaled corticosteroids in time to treatment failure," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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