Detection and treatment of early asthma.

Background: We sought answers to two questions: 1) how can mild, early asthma best be detected? 2) how should it be treated and the treatment effect monitored? Methods: Eighty adult patients with early, mostly mild asthma and 30 control subjects were examined by lung-function and biochemical tests. Patients were randomly assigned to two treatment groups. One group was treated with an inhaled steroid (budesonide) for 6 weeks, and the other first with an inhaled β2-agonist (terbutaline) for 6 weeks and then with an inhaled steroid for 2 weeks. Results: Treatment with budesonide was effective: symptom scores, PEF, blood eosinophils, and sputum ECP values all improved. Terbutaline was ineffective by these criteria. For the detection of early asthma and for the following treatment effects, sputum and serum ECP assays are useful supplements to lung-function tests. Conclusions: Treatment of early, mild asthma with an inhaled steroid is effective and worthwhile. Detection of the disease remains a problem, as both lung-function and biochemical tests have low sensitivities.