Low-dose budesonide treatment improves lung function in patients with infrequent asthma symptoms at baseline: A post-hoc analysis of the start study

RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for improving asthma outcomes, including lung function. In the past, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, evidence is lacking for the benefit of ICS in patients with less frequent symptoms at presentation. This was investigated in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4-66 years (median 21 years) with a history of recent-onset mild asthma (11 years] or 200 mug [patients aged 1-2 symptom days/week). Pre- and post-bronchodilator FEV1 were analyzed using linear mixed models with a compound symmetry covariance structure, adjusted for region, visit time, age group, smoking status, and sex. RESULTS: Overall, 7138 patients were included in this analysis (budesonide, n=3577; placebo, n=3561). At baseline, symptom frequency was 0-1 days/week for 2184 (30.6%), >1-2 for 3040 (42.6%) participants. In all symptom frequency groups, patients treated with budesonide experienced greater improvements in pre-bronchodilator FEV1 % predicted (analyzed at Years 1 and 3) compared with those who received placebo, although the mean difference was slightly lower for all groups at Year 3 compared with Year 1. Patients receiving budesonide also demonstrated lower reductions in post-bronchodilator FEV1 % predicted over 1 year and 3 years compared with patients on placebo, in all symptom frequency groups (Figure). CONCLUSIONS: Long-term, once-daily, low-dose budesonide treatment plus usual asthma medication improves lung function in patients with mild, recent-onset asthma. These beneficial effects were seen even in patients with the lowest baseline asthma symptom frequency (0-1 days/week).