Regularly inhaled β-agonists with steroids are not harmful in stable asthma

Abstract

Regular use of inhaled β-agonists with steroids was not harmful in stable asthma. Morning and evening peak expiratory flow (PEF) values were recorded daily for 1 week (week 1) before regular inhalation of β-agonists and steroids. Then β-agonists were withdrawn and used as needed for a 2-week washout period. The PEF values of the first week (week 1) were compared with the PEF values before treatment during a further 1-week period (week 4) of as-needed use of β-agonists. The mean evening PEF values were significantly higher (difference = 9.55 L/min; p = 0.017; 95% confidence interval [CI], 1.80 to 17.30 L/min), and the mean morning PEF values were nearly significantly higher (difference = 6.49 L/min; p = 0.088, 95% CI, −0.99 to 14.00 L/min) during regular β-agonist use. There were significantly more patients with more symptom days, including nights with awakening, during as-needed treatment (difference in ratio of patients = 40.74%; p = 0.0001; 95% CI, 20.21% to 61.27%). When nocturnal symptoms are considered separately, there were more patients with more nights with awakening during as-needed treatment with a nearly significant difference (difference in ratio of patients = 12.96%; p = 0.0654; 95% CI, 0.92 to 25.00%). PEF monitoring should be used to distinguish the majority of patients with asthma who have higher PEF values during regular treatment from those who do better with administration of β-agonists as needed. To deny patients with asthma regular use of small doses of β-agonists in general is to deny individual differences among patients with asthma.