By LINDA A. JOHNSON

Associated Press Writer

5:52 PM PDT, April 13, 2005

People with mild asthma may not need daily medicine to prevent flare-ups, as doctors now recommend. A study found that patients who take medicine only when asthma attacks occur fare about as well as those who swallow a pill or use inhaled steroids every day.

If a bigger, longer study confirmed the results and patients with mild asthma switched to attacks-only treatment, about $2 billion a year would be saved on medication in the United States, lead researcher Dr. Homer A. Boushey said.

His team found that over a year, patients who took daily medicine to limit airway inflammation had about the same number of severe asthma attacks and changes in lung function, and reported similar quality of life, as those who used asthma inhalers only when flare-ups occurred. Asthma attacks can include wheezing, shortness of breath and tightness in the chest.

"We may now have another way to treat adults with mild persistent asthma -- with intermittent treatment," said James Kiley, director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute, which funded the study.

But Kiley and other experts warned that asthma patients should not stop taking their "controller" medicine without consulting a doctor.

"There are major risks of not taking your asthma medication, including death," cautioned Boushey, director of the Asthma Clinical Research Center at University of California-San Francisco.

Also, experts noted the findings do not apply to severe asthma sufferers or to children, who were not part of the study.

The study was reported in Thursday's New England Journal of Medicine.

Boushey noted that many patients prescribed a daily asthma controller drug often fail to renew their prescriptions. That prompted him to compare daily and attacks-only treatment. The conclusion: "Maybe they don't have to take it every day."

That would spare some patients the expense and inconvenience of taking daily medicine, as well as some side effects -- primarily thinning of bones.

About 20 million Americans have asthma, with about one-quarter classified as having mild, persistent asthma, in which attacks occur more than twice a week but not daily.

Current guidelines from the National Asthma Education and Prevention Program recommend daily, long-term use of an inhaled steroid or a leukotriene-blocking pill such as Singulair for these people.

Kiley said government scientific advisers will review the new findings and could make changes in the guidelines, which are set to be updated in 2006.

Boushey and colleagues studied 225 adults with mild persistent asthma, divided into three groups. One used an inhaled steroid daily, the second took a daily asthma pill, and the third used an inhaler only when symptoms appeared.

After a year, those getting the inhaled steroid each day had about 26 more days a year without symptoms, but still reported the same quality of life as the two other groups.

The findings are likely to be controversial, given that earlier research showed daily treatment not only prevents symptoms but may also limit the progressive loss of lung function. The current guidelines were based on those earlier studies.

But Dr. Leonard Bielory, director of the Asthma and Allergy Research Center at University of Medicine and Dentistry of New Jersey in Newark, said that given the new study, he may try taking some patients off their preventive medicine and switch others to the lowest dose possible.

"This now ethically permits us to pursue a longer-term study of intermittent treatment," he added, because the study shows the strategy did not harm patients.

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On the Net: http://www.nejm.org

American Academy of Allergy, Asthma & Immunology: http://www.aaaai.org

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