For years, people with asthma have been told to take an inhaled steroid every day to keep their disease under control. Now, a new study suggests that those who follow that advice don’t actually do much better than those who use their “rescue” puffers and their steroid inhalers only when they have symptoms.

The study’s authors say their findings suggest that asthma patients might be able to put away their steroid inhalers and follow a simpler and far less expensive approach instead.

But at least one Canadian asthma expert disagrees with the study’s conclusions.

“I think if people look at the headline of this study without looking at the data in the study, this could be dangerous to them,” Dr. Mark Greenwald,an assistant professor of medicine at the Universityof Torontoand a member of the Asthma Society of Canada, tells CTV News.

The study looked at whether daily corticosteroid benefits patients. It’s thought that they do, even when there are no symptoms, because they help to keep airway inflammation down.

But the majority of patients don’t stick with the inhaler, and tend to rely more on their rescue puffers. In fact, according to senior author Dr. Homer A. Boushey, a professor of pulmonary and critical care medicine at UCSF, just a third of the inhaler prescriptions are renewed even once in the U.S.

"So we wondered what would happen if people with mild asthma already well controlled by daily treatment with an inhaled corticosteroid instead took a puff only when they used their rescue medication – usually albuterol -- for relief of symptoms,” he explained in a news release.

In all, 342 adults with mild to moderate asthma took part in the study over nine months. They were randomly assigned three approaches to try controlling their asthma:

  • Inhaler and dosage adjustments every six weeks by their doctor
  • Inhaler adjustments every six weeks based on the results of a test to measure exhaled nitric oxide
  • Symptom-based adjustment, meaning whenever symptoms occurred, patients took one puff of inhaled corticosteroid for every puff of their “rescue” albuterol inhaler

The study found that it didn’t matter which approach the patients took; their frequency of flare-ups of asthma, symptom severity, and their pulmonary function was about the same.

As well, the patients who took the steroid inhaler only when they had symptoms used only half as much medication as the other groups, but did not have more severe symptoms. Nor did they miss more days of work or school.

The findings appear in this week’s issue of the Journal of the American Medical Association.

But Dr. Greenwald says while the study was rigorous and performed by high-level researchers, it looked only at a small group of patients. What’s more, it didn’t assess the long-term effects of an intermittent treatment approach.

Greenwald says he doesn’t like the conclusions the researchers reached.

“To say ‘Ok, you can do what you want,’ that shouldn’t be the message. There should be the caution that if you’re going to make a change, discuss it with your physician,” he says

Greenwald says he looked at the study data and doesn’t agree that it showed that intermittent corticosteroid therapy can keep patients as healthy as other forms of physician-directed therapy.

“This study does not give proof that it’s okay to do this and that it’s going to save us money,” he said.

He notes that even those patients in the study with mild asthma were still having asthma flare-ups, or “exacerbations,” which is something that patients and doctors should be trying to avoid.

“Because exacerbations lead to permanent deterioration of lung function,” he explained. “Its impacts are irreversible. So at all costs we want to reduce the number of exacerbations.”

With a report from CTV’s John Vennavally-Rao