Detection and treatment of early asthma

Background: We sought answers to two questions: 1) how can mild, early asthma best be detected? 2) how should it be treated and the treatment effect monitored? Methods: Eighty adult patients with early, mostly mild asthma and 30 contro l subjects were examined by lung-function and biochemical tests. Patients w ere randomly assigned to two treatment groups. One group was treated with a n inhaled steroid (budesonide) for 6 weeks, and the other first with an inh aled beta(2)-agonist (terbutaline) for 6 weeks and then with an inhaled ste roid for 2 weeks. Results: Treatment with budesonide was effective: symptom scores, PEF, bloo d eosinophils, and sputum ECP values all improved. Terbutaline was ineffect ive by these criteria. For the detection of early asthma and for the follow ing treatment effects, sputum and serum ECP assays are useful supplements t o lung-function tests. Conclusions: Treatment of early, mild asthma with an inhaled steroid is eff ective and worthwhile. Detection of the disease remains a problem, as both lung-function and biochemical tests have low sensitivities.