Clinical Citations: Can early therapy with inhaled steroids limit asthma-related damage?

Can early intervention with inhaled corticosteroids help prevent irreversible lung function decline in patients with asthma? Yes, according to results of the international Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) study.

In this randomized double-blind investigation, researchers studied the effects of low-dose budesonide initiated within the first 2 years of diagnosis in patients with persistent asthma. In the study, 7165 patients, aged 5 to 66 years, received budesonide (200 µg qd for children younger than 11 years and 400 µg qd for patients aged 11 years and older) in addition to their regular asthma medications.

Treatment with budesonide significantly improved prebronchodilator and postbronchodilator forced expiratory volume in 1 second (FEV₁) percentage of predicted. For postbronchodilator FEV₁, treatment reduced mean declines from baseline at 1 and 3 years by 20.62% and 21.79%, respectively, versus 22.11% and 22.68%, respectively, for placebo (P < .001). The most significant treatment effects were in patients who were male, active smokers, and older than 18 years; the least significant effects were in adolescents.

These findings suggest that a delay in treating asthma early in the course of the disease may result in airway abnormalities that are less responsive to inhaled corticosteroid treatment later.