Comparison of high and low dose of the inhaled steroid, budesonide, as an initial treatment in newly detected asthma

The importance of early initiation of inhaled steroids even in mild asthma has been documented in several studies. It is not, however, clear whether t he treatment should be started with a high or a low dose of the inhaled ste roid. We have compared the effects of high and low dose inhaled steroid, bu desonide, in patients with newly detected asthma. We studied 101 adult patients with newly detected bronchial asthma who were without inhaled steroid or any regular pharmacological treatment for their asthma. The patients were randomly allocated to two treatment groups: one to receive 800 mu g inhaled budesonide per day and the other to receive 200 mu g inhaled budesonide per day. The drugs were given with a Turbuhaler(R) dry powder inhaler. During the 3-month treatment period, no significant di fferences between the treatment groups were noted in morning or evening PEF values, in spirometric parameters, in asthmatic symptoms or in the use of rescue beta(2)-agonists. The decrease in bronchial hyperresponsiveness was, however, more marked in the high dose budesonide group, reaching a borderl ine significance (P = 0.10 high vs. low dose budesonide). In addition, in s erum markers of asthmatic inflammation significant differences were shown b etween the treatment groups. The decrease in the number of blood eosinophil s during the treatment was more marked in the high dose budesonide group (P = 0.02; high vs. low dose budesonide). In serum ECP no change was observed in the low hose budesonide group, but a marked decrease in the high-dose b udesonide group (P = 0.008; high vs. low dose budesonide). The change was e ven more marked with regard to serum EPX (P = 0.005; high vs, low dose bude sonide). Our results support the view that the treatment of newly detected asthma sh ould be started with a high dose of inhaled steroid. The low dose may not b e enough to suppress asthmatic inflammation despite good clinical primary r esponse.