Lancet 2016 Nov 29 – the START study.
Researchers examined benefit of low-dose inhaled budesonide given within 2 years of mild asthma diagnosis in children and adults.
n = 4098 patients with symptoms ≤3 days weekly randomized to budesonide or placebo
Doses: 400 mcg in adults, 200 mcg in children
Budesonide recipients had fewer severe asthma-related events, fewer courses of PO steroids, and about 1% less lost FEV1 over 3 years. Minimal improvement in symptom scores and no change in mortality.
But…You’d have to treat a patient daily for 10 years to prevent 1 exacerbation requiring PO steroids. Is this worth it?
ICS for mild, intermittent asthma shows small benefit, but probably not enough to justify a practice or guideline change.