title: Treatment of mild asthma with inhaled corticosteroids: is discontinuation of therapy possible?
abstract: BACKGROUND
  This study investigated if long-term therapy with inhaled corticosteroids could be discontinued in mild asthma when patients are in a clinically stable phase of the disease. Data were derived from a 2-year randomized, controlled, bronchodilator intervention study in family practice.
  
  
  METHODS
  The experimental (stop-steroid) group consisted of 19 asthmatic patients who had used inhaled corticosteroids daily during at least the year preceding this study and who stopped using these drugs because of participation in the bronchodilator intervention study. The control (no-steroid) group consisted of 70 patients with asthma who had not used corticosteroids in the year preceding the study. At the start of the study (8 weeks after stopping steroids), the two groups were completely comparable in all other relevant characteristics. During the 2-year study, patients were treated only with a bronchodilator (salbutamol or ipratropium bromide). Outcome measures were: exacerbations, symptoms, annual decline in forced expiratory volume in 1 second (FEV1), annual change in nonspecific bronchial responsiveness (PC20-histamine), and the need for additional corticosteroid therapy because of symptoms of increased airway obstruction.
  
  
  RESULTS
  In the stop-steroid group, 12 of 19 patients (63%) dropped out during the study period because of a deterioration of their clinical condition and need for additional (inhaled) corticosteroid treatment. In the no-steroid group, only eight patients dropped out for this reason (11%). In the stop-steroid group, who did not use steroids for at least 1 year, the annual FEV1 decline was much larger than in the comparison subjects (165 vs 40 ml/yr).
  
  
  CONCLUSIONS
  Stopping maintenance treatment with inhaled corticosteroids may not be advisable in all patients with mild asthma. Instead of stopping or interrupting treatment, family physicians are advised to determine the minimal effective daily dose of inhaled corticosteroids for each individual patient that provides adequate control of the disease.
authors.affiliation: Department of General Practice, Nijmegen University, Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: van Grunsven
authors.forename: E
authors.initials: E
authors.lastname: Dompeling
authors.forename: C P
authors.initials: CP
authors.lastname: van Schayck
authors.forename: J
authors.initials: J
authors.lastname: Molema
authors.forename: H
authors.initials: H
authors.lastname: Folgering
authors.forename: C
authors.initials: C
authors.lastname: van Weel
mesh_terms: D000280:Administration, Inhalation; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001249:Asthma / Q000188:drug therapy*; D001985:Bronchial Provocation Tests; D005260:Female; D005541:Forced Expiratory Volume; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D013256:Steroids; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D013256:Steroids