Asthma Control following Initial Inhaled Corticosteroid Monotherapy in Mild to Moderate Asthma: A 4- to 8-Week Observational Study

Abstract

Background: There is an increasing trend for the use of combination therapy of inhaled corticosteroids (ICS) and long-acting β₂-agonists as initial treatment for asthma. Objective: To assess the efficacy of initial monotherapy with ICS for achieving asthma control in steroid-naive mild to moderate asthmatics. Method: During an observational survey, steroid-naive patients received ICS in a dosage of 400–2,000 µg/day. After 4–8 weeks’ treatment, achievement of asthma control, defined according to the Global Initiative for Asthma (GINA) guidelines, was assessed and the Asthma Control Questionnaire (ACQ) was completed. Results: Among 537 selected patients, 21 were excluded because of severe asthma and 96 because of inadequate ICS daily dosage. Four hundred and twenty patients were analyzed, 396 (94%) of whom completed the survey. Mean ICS dosage, in equivalent beclomethasone, was 479 ± 62 µg/day for mild asthma (group A) and 1,115 ± 306 µg/day for moderate asthma (group B). Asthma control was achieved for 71 and 65% of the patients, mean ACQ score improved from 1.1 ± 0.6 to 0.5 ± 0.5 (p < 0.001) and from 2.0 ± 0.8 to 0.8 ± 0.7 (p < 0,001), and FEV₁ (% predicted) improved from 93 ± 9 to 96 ± 13 (p < 0.05) and from 85 ± 15 to 91 ± 15 (p < 0.001) for groups A and B, respectively. Conclusion: Asthma control can be achieved by ICS monotherapy for two thirds of steroid-naive patients with mild to moderate asthma. For these patients, we suggest that ICS alone could be started as initial therapy and that additional therapy should be considered after 4–8 weeks for patients who do not achieve control.