A regular or an intermittent treatment for asthma: the long-term effect

B. Sposato, A. Pammolli*, L. Bove, R. Barzan, A. Ricci**, M. Scalese§, S. Mariotta**, C. Franco

U.O. Pneumology, “Misericordia” Hospital, Grosseto (Italy) *Department of Physiopathology, Experimental Medicine and Public Health, “Le Scotte” Hospital, Siena (Italy) **U.O.C. Pneumology, Sant’Andrea Hospital, “La Sapienza” University, Rome (Italy) §Clinical Physiology Institute, CNR Pisa (Italy)

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• Respiratory Medicine

Objectives: Many asthmatics take therapy intermittently because of their scarce compliance. It is not known if this is effective in controlling and slowing down the lung function decline in asthma. Our aim was to compare the effect of a regular treatment and an intermittent one on some clinical aspects and on the forced expiratory volume 1 (FEV1) decline in 165 persistent asthmatics with FEV1 >70% (60 men; age 40.87±14.05; FEV1 95.03±13.1%), in a retrospective way over 4 years.

Patients and Methods: Eighty-four patients took inhaled corticosteroids (ICSs) plus long-acting bronchodilator agents (LABAs) regularly (Regular) and 81 patients took ICSs plus LABAs intermittently for short periods when symptoms appeared (Intermittent).

Results: Less patients (p < 0.05) took oral corticosteroids, short-acting bronchodilators as needed in Regular compared to Intermittent. More patients increased the therapy (step-up) in Intermittent (p < 0.01) More patients reported a subjective improvement while fewer reported a worsening in Regular (p < 0.05). After 4 years, the variation in maximal mid expiratory flow (FEF25-75) was lower in Regular (-159.40±472.79 ml/sec; CI 95% -261.99, 56.82) than in Intermittent (-324.44±569.97 ml/sec; CI 95% -450.48, -198.41); whereas the FEV1 decline was similar between Regular (-276.97±199.37 ml; CI 95% -316.24, -229.71) and Intermittent (-317.65± 194.05 ml; CI 95% -360.56, -274.74). In males and females, in smokers and non-smokers no differences were found in the FEV1 decline.

Conclusions: In conclusion, the Regular use of ICSs plus LABAs is better than the irregular use of them in controlling asthma over a long period of time. Whereas, after 4 years the Regular treatment may not decrease the FEV1 decline more effectively than the Intermittent therapy.

Corresponding Author: Bruno Sposato, MD; e-mail: bsposat@tin.it

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