Inhaled corticosteroid therapy for patients with persistent asthma: learnings from studies of inhaled budesonide

Inhaled corticosteroids (ICSs) are recommended for patients with asthma who use a short-acting beta(2)-adrenergic agonist more than twice weekly--a key indicator of disease persistency. Much knowledge about the long-term benefits of ICSs in persistent asthma stems from studies of the ICS budesonide, which have shaped current asthma guidelines. Results of the 3-year double-blind phase of the inhaled Steroid Treatment As Regular Therapy study indicated that early ICS treatment improves impairment and reduces future risk of severe exacerbations by 44% in adults and children with ICS-naive, recent-onset persistent asthma. These benefits were maintained or improved during the 2-year open-label phase; however, the benefit of very early versus later introduction of ICS treatment on pulmonary function could not be established. Similarly, in the Childhood Asthma Management Program (CAMP) study, ICS treatment did not alter the progression of asthma. The CAMP study, however, highlighted the need for continued daily ICS treatment, thus providing evidence for the new asthma guidelines' focus on improving asthma control versus altering natural history. In patients not controlled on daily ICSs alone, the Oxis and Pulmicort Turbuhaler in the Management of Asthma (OPTIMA) and Formoterol And Corticosteroids Establishing Therapy (FACET) studies of budesonide showed benefit of ICS combination therapy with a long-acting beta(2)-adrenergic agonist (LABA). Taken together, these studies show the efficacy of daily ICS therapy in patients with mild to moderate persistent asthma, support the benefits of initiating ICSs early and continuing treatment, and underscore the need to increase to ICS/LABA in those uncontrolled on ICS alone.