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

Objectives: Many asthmatics take therapy intermittently because of their scarce compliance. It is not known if this is ef- fective in controlling and slowing down the lung function decline in asthma. Our aim was to com- pare the effect of a regular treatment and an in- termittent 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 corti- costeroids, short-acting bronchodilators as need- ed in Regular compared to Intermittent. More pa- tients increased the therapy (step-up) in Intermit- tent (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 differ- ences 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 Regu- lar treatment may not decrease the FEV1 decline more effectively than the Intermittent therapy.