Inhaled Steroids of Minimal Benefit in Mild Asthma

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.



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