Inhaled steroids for asthma is the recommended first-line treatment for patients who are uncontrolled. Inhaled steroids have led to fewer hospitalizations and deaths over the past 10-15 years.
Recent Global Initiative for Asthma guidelines, recommend in mild asthma, intermittent use of an inhaled steroid and long acting beta-2 agonist (LABA) on an as needed basis for patients in treatment step 1. Past guidelines recommended albuterol as an add needed basis for those patients. More moderate to severe patients are recommended to use an inhaled steroid on a continual basis. Many patients remain controlled taking these medications, but because of compliance issues, there are those who stop inhaled steroids.
A recent study published in the Annals of Allergy, Asthma and Immunology titled “Discontinuation of inhaled corticosteroids (DISCO) in patients with controlled asthma” looked to determine the clinical outcomes of discontinuing inhaled steroids in patients with well controlled mild asthma.
They investigated the clinical outcomes of stopping inhaled steroids in patients versus patients who continued treatment. The time to loss of control was measured.
The conclusions of the study showed a significant difference in the time to loss of control between the steroid withdrawal group versus those who continued treatment. Other markers seen in those to stopped inhaled steroids were, increased fractional exhaled nitric oxide levels, sputum eosinophil counts and serum total immunoglobulin E levels.
Therefore the study suggests that the maintenance of inhaled steroids may help keep patients’ asthma under control in those with mild, well-controlled asthma, which is associated with good clinical outcomes.
Compliance with asthma medication can be difficult with patients. In practice, patients stop inhaled steroids without consulting a physician. Previous studies have shown that those who stop inhaled steroids can have mild loss of control to acute asthma exacerbations. Thus the regular use of them has been emphasized. However there are potential long term side effects such as osteoporosis, diabetes and skin thinning. So additional considerations need to be taken account for individual patients whether or not one is able to stop inhaled steroids if they are well controlled.