Inhaled corticosteroids in mild asthma

Paul M. O’Byrne, MB, is a professor of medicine and dean and vice-president of the Faculty of Health Sciences at McMaster University.

How should we identify patients with mild asthma who really need regular treatment with inhaled corticosteroids (ICS)?

The use of regular inhaled steroids is still the most clinically effective approach to treating patients with milder asthma.

The problem has always been with adherence to regular treatment for patients who are asymptomatic a lot of the time. We know that adherence to regular daily inhaled steroids is very poor. It’s for that reason that using a treatment approach with a reliever that contains both an inhaled steroid and a rapid-onset but long-acting inhaled beta₂-agonist, such as formoterol, is now recommended for many, many patients who have mild asthma.

But it’s really because of the recognition that it is very difficult to convince patients to use the inhaled steroids as their maintenance treatment. Therefore many patients as a result of that tend to rely only on a reliever, used from time to time. If that’s the case, the reliever should contain an inhaled steroid.