美国国家公共电台 NPR Study Questions Mainstay Treatment For Mild Asthma（在线收听）

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About 26 million Americans have asthma. Many carry a rescue inhaler for when they have an attack, and they might also use a steroid inhaler to prevent future attacks. But there's a recent study suggesting these prevention inhalers might not actually work. From member station KQED in San Francisco, April Dembosky reports.

APRIL DEMBOSKY, BYLINE: Since the early '90s, the gold standard for treating patients with mild asthma is to use a low-dose steroid inhaler every day. The thinking was if people with mild symptoms used the inhaler early on, it would prevent permanent damage to their airways. But when the medications didn't seem to help stave off asthma attacks, doctors like Stephen Lazarus blamed the patients.

STEPHEN LAZARUS: I think we've attributed their poor asthma control to the fact they weren't taking their medicines. And it may be that many of them were taking their medicines - they just weren't working.

DEMBOSKY: Dr. Lazarus and his team at the University of California in San Francisco decided to look into it. They studied 300 patients with mild asthma. And in the end, more than half of them did just as well or better on a placebo inhaler as those that used the real steroid inhaler, mometasone.

LAZARUS: We may be giving people steroids, subjecting them to potential adverse effects and the increased cost, without a significant clinical benefit.

DEMBOSKY: Merck, the drug company that makes mometasone, declined to comment on the study. While inhaled steroids are generally safe, there is some risk for cataracts, glaucoma and bone loss. That has long been a concern for asthma patient Suzanne Leigh.

SUZANNE LEIGH: I'm a low-BMI white woman with history of autoimmune disease, which puts me at high risk for osteoporosis.

DEMBOSKY: She works in the university's media department. And when she read the study, she was frustrated. She takes an asthma drug that costs $500, and it increases her chances of breaking a hip down the line. And it may not even work.

LEIGH: I don't know where I go from here. Do I continue with the medication, or do I stop and end up in the emergency department?

DEMBOSKY: Dr. Lazarus tells Leigh if the drug stops her from waking up in the middle of the night unable to breathe, then it doesn't matter what the data says. She should continue using it. But in general, he says there is no magic lab test that can show which asthma patients will respond to inhalers and which ones won't.

LAZARUS: If you have people who are taking inhaled steroids, and they're not responding, the answer is not necessarily to just continue to escalate the dose but to question whether there's an alternative.

DEMBOSKY: Lazarus says these results suggest it's time to re-evaluate standard treatments for mild asthma. For NPR News, I'm April Dembosky in San Francisco.

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