title: Insights into early treatment of mild asthma: do inhaled corticosteroids make a difference?
abstract: Approaches to the management of moderate-to-severe persistent asthma in both children and adults are widely accepted but the treatment of mild persistent asthma remains controversial because of the lack of agreement on what constitutes mild asthma and whether regular treatment is required at all. Recent evidence indicates that 'mild asthma' may not be as benign a condition as was widely believed and should be treated to improve asthma control and to prevent the significant burden of exacerbation and progression of disease. This is supported by compelling evidence from histologic and clinical studies that have attributed irreversible pathologic and functional airway changes to consequences of persistent airway inflammation and under-treated asthma. This article focuses on the rationale of early treatment of mild persistent asthma, and discusses the various findings from the largest randomized, early-intervention trial with inhaled corticosteroids as regular treatment in patients with asthma of recent onset--the START (inhaled Steroid Treatment As Regular Therapy in early asthma) study. A brief review of the background of the natural history of asthma, the findings from key longitudinal epidemiologic studies on disease progression in children and adults, and the effect of inhaled corticosteroids on this progression are included, to provide further insight into the impact of early treatment on asthma management guidelines.
authors: University of British Columbia, iCapture Centre for Cardiovascular and Respiratory Diseases, St Paul's Hospital, Vancouver, British Columbia, Canada. wtan@mrl.ubc.ca
authors: Wan C
authors: WC
authors: Tan
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D018450:Disease Progression; D005541:Forced Expiratory Volume / Q000187:drug effects*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index
chemical_list: D005938:Glucocorticoids
references: Respir Med. 1994 May;88(5):373-81
references: 8036306
references: Respirology. 2006 Nov;11(6):767-75
references: 17052306
references: N Engl J Med. 1988 Oct 27;319(17):1112-7
references: 3173442
references: Am J Respir Crit Care Med. 2002 Jun 1;165(11):1467-8
references: 12045117
references: Ann Allergy Asthma Immunol. 2005 May;94(5):517-27; quiz 527-9, 574
references: 15945553
references: Thorax. 2002 Apr;57(4):309-16
references: 11923548
references: N Engl J Med. 1997 Nov 13;337(20):1412-8
references: 9358138
references: Trends Pharmacol Sci. 1993 Jul;14(7):275-9
references: 8105598
references: Am Rev Respir Dis. 1990 Aug;142(2):434-57
references: 2200318
references: N Engl J Med. 1994 Sep 15;331(11):700-5
references: 8058076
references: Am Rev Respir Dis. 1993 Nov;148(5):1220-5
references: 8239157
references: Annu Rev Immunol. 2004;22:789-815
references: 15032597
references: Thorax. 2002 May;57(5):388-92
references: 11978912
references: Am Rev Respir Dis. 1993 Apr;147(4):811-7
references: 8466114
references: J Allergy Clin Immunol. 2005 Apr;115(4):708-13
references: 15805988
references: Pediatr Allergy Immunol. 2006 May;17 Suppl 17:21-7
references: 16573705
references: Am Rev Respir Dis. 1993 Mar;147(3):697-704
references: 8442607
references: Thorax. 1996 Aug;51(8):815-8
references: 8795670
references: J Allergy Clin Immunol. 1992 Jul;90(1):32-42
references: 1629507
references: N Engl J Med. 2003 Oct 9;349(15):1414-22
references: 14534334
references: Pediatr Pulmonol. 1997 Jan;23(1):14-20
references: 9035194
references: Pediatr Allergy Immunol. 2006 May;17 Suppl 17:14-20
references: 16573704
references: N Engl J Med. 1991 Aug 8;325(6):388-92
references: 2062329
references: Thorax. 2006 Feb;61(2):105-10
references: 16308336
references: Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1308-13
references: 11029336
references: Ann Allergy Asthma Immunol. 2005 Dec;95(6):566-70
references: 16400897
references: Control Clin Trials. 2001 Aug;22(4):405-19
references: 11514041
references: N Engl J Med. 1998 Oct 22;339(17):1194-200
references: 9780339
references: J Pediatr. 1994 May;124(5 Pt 1):681-8
references: 8176553
references: Pediatr Allergy Immunol. 1999 May;10(2):89-95
references: 10478609
references: Am J Respir Crit Care Med. 1997 Sep;156(3 Pt 1):951-8
references: 9310019
references: J Allergy Clin Immunol. 2006 Nov;118(5):1040-7
references: 17088127
references: Am J Respir Crit Care Med. 1995 Sep;152(3):865-71
references: 7663797
references: Clin Exp Allergy. 1998 May;28(5):568-77
references: 9645593
references: Am J Respir Crit Care Med. 2005 Aug 15;172(4):410-2; discussion 415-6
references: 16081553
references: Chest. 2006 Jun;129(6):1478-85
references: 16778264
references: Pediatr Allergy Immunol. 2006 May;17 Suppl 17:7-13
references: 16573703
references: N Engl J Med. 2000 Oct 12;343 (15):1054-63
references: 11027739
references: Eur Respir J. 2002 Jan;19(1):182-91
references: 11843317
references: N Engl J Med. 2006 Oct 19;355(16):1682-9
references: 17050892
references: Am J Respir Crit Care Med. 2000 May;161(5):1720-45
references: 10806180
references: Cochrane Database Syst Rev. 2005 Apr 18;(2):CD005307
references: 15846751
references: Thorax. 2006 Feb;61(2):100-4
references: 16443705
references: Proc Am Thorac Soc. 2004;1(3):176-83
references: 16113432
references: Int J Clin Pract. 2005 Jun;59(6):692-703
references: 15924598
references: Chest. 1995 Nov;108(5):1228-34
references: 7587421
references: Clin Chest Med. 2000 Jun;21(2):331-43, ix
references: 10907592
references: N Engl J Med. 2006 May 11;354(19):1985-97
references: 16687711
references: Am J Respir Crit Care Med. 2001 Oct 15;164(8 Pt 1):1392-7
references: 11704584
references: Eur J Respir Dis. 1987 Mar;70(3):171-9
references: 3569449
references: Can Respir J. 2004 May-Jun;11 Suppl A:9A-18A
references: 15254605
references: Am Rev Respir Dis. 1980 Feb;121(2):339-42
references: 7362140
references: Eur Respir J. 2007 Feb;29(2):379-89
references: 17264325
references: Lancet. 2003 Mar 29;361(9363):1071-6
references: 12672309
references: N Engl J Med. 2005 Apr 14;352(15):1519-28
references: 15829533
references: Am Rev Respir Dis. 1992 Jun;145(6):1251-8
references: 1595987
references: Eur Respir J. 2000 Jan;15(1):151-7
references: 10678638
references: Am Rev Respir Dis. 1990 Dec;142(6 Pt 1):1407-13
references: 2252260
references: N Engl J Med. 2001 Feb 1;344(5):350-62
references: 11172168