Patients whose asthma symptoms are only mild and intermittent usually don’t need daily asthma medications.  They just use a rescue inhaler, like albuterol, whenever symptoms come up.

Patients with daily or almost daily symptoms, on the other hand, need daily preventive medications to control their asthma.  The first choice for a preventive asthma medicine is a low dose of an inhaled steroid.  If this first choice doesn’t control symptoms well, patients generally face a choice between increasing the inhaled steroid dose and adding an inhaled long-acting beta agonist (LABA).  LABAs have fallen under some disfavor recently as studies have shown that they can increase the risk of severe asthma exacerbations and, rarely, death.  (See the link to my post, below.)

This month, the New England Journal of Medicine published a study that gives asthma patients a new option.  In the study, asthma patients who were not adequately controlled on a low dose steroid inhaler were randomized to three groups.  One group received a higher dose inhaled steroid.  A second group received a low dose inhaled steroid plus a LABA.  The third group received a low dose inhaled steroid plus Spiriva (tiotropium).  Spiriva is a once-daily inhaled medicine that has been proven effective in emphysema but has not been tested in asthma until now.

Asthma symptoms and lung function were better in the Spiriva group than in the high-dose steroid group.  And the Spiriva group did no worse than the LABA group.

Spiriva is already the first-line medication of choice in emphysema. If longer trials demonstrate its safety in asthma, it may be the ideal medicine to add if a low-dose inhaled steroid isn’t enough.

Learn more:

LA Times article:  Spiriva is an alternative for adult asthmatics, researchers say

New England Journal of Medicine article:  Tiotropium Bromide Step-Up Therapy for Adults with Uncontrolled Asthma

New England Journal of Medicine editorial:  Anticholinergics for Patients with Asthma?

My post about the dangers of long acting beta-agonists:  Alarms about Asthma Agents

Tangential miscellany:

US Airways Magazine just republished my post Rethinking Calcium Supplements.  So if you’re flying US Airways in October, grab a copy.