COMPARISON OF REGULARLY SCHEDULED WITH AS-NEEDED USE OF ALBUTEROL IN MILD ASTHMA

Background Inhaled beta-agonists are the most commonly used treatment for asthma, but data suggest that regularly scheduled use of these age nts may have a deleterious effect on the control of asthma. We compare d the effects of regularly scheduled use of inhaled albuterol with tho se of albuterol used only as needed in patients with mild chronic, sta ble asthma. Methods In a multicenter, double-blind study, we randomly assigned 255 patients with mild asthma to inhale albuterol either on a regular schedule (126 patients) or only as needed (129 patients). The patients were followed for 16 weeks. Results The primary outcome indi cator, peak expiratory air flow measured in the morning, did not chang e significantly during the treatment period in the scheduled (416 lite rs per minute after the run-in period and 414 liters per minute after the treatment period) or the as-needed (424 liters per minute at both times) treatment groups (P = 0.71). There were no significant differen ces between the two groups in peak flow variability, forced expiratory volume in one second, the number of puffs of supplemental albuterol n eeded, asthma symptoms, asthma quality-of-life score, or airway respon siveness to methacholine. The statistically significant differences be tween the groups in evening peak flow and in the shortterm bronchodila tor response to inhaled albuterol were small and judged to be clinical ly unimportant. Conclusions In patients with mild asthma, neither dele terious nor beneficial effects derived from the regular use of inhaled albuterol beyond those derived from use of the drug as needed. Inhale d albuterol should be prescribed for patients with mild asthma on an a s-needed basis. (C) 1996, Massachusetts Medical Society.