Budesonide Decreases Risk of Adverse Events Regardless of Asthma Severity

Once-daily budesonide—an inhaled corticosteroid (ICS)—is associated with fewer severe asthma events in patients with mild asthma, even in those with infrequent symptoms, according to a recent study. 

Although ICS are highly effective for reducing asthma exacerbations, guidelines often only recommend ICS for patients with symptoms on more than 2 days per week. However, there is little evidence to support this cutoff.

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Researchers conducted a post-hoc analysis of the Steroid Treatment as Regular Therapy study, involving 7138 patients with mild asthma and no previous corticosteroid use randomized to receive either once daily, inhaled budesonide 400 μg or placebo.

Of the 7138 participants, 31% had symptom frequency of 0-1 days, 27% had symptom frequency between 1-2 days per week, and 43% had symptom frequency of more than 2 days per week.

For budesonide versus placebo, time to first severe asthma-related event (SARE) was longer across symptom frequency subgroups (hazard ratios 0.54 for 0-1 symptoms, 0.60 for >1 to ≤2 symptom days per week, and 0.57 for >2 symptom days per week. Severe exacerbations requiring oral or systemic corticosteroids were also reduced, and prebronchodilator lung function was higher among those taking budesonide versus those taking placebo.

“In mild recent-onset asthma, once daily, low-dose budesonide decreases SARE risk, reduces lung function decline, and improves symptom control similarly across all symptom subgroups. The results do not support restriction of inhaled corticosteroids to patients with symptoms on more than 2 days per week and suggest that treatment recommendations for mild asthma should consider both risk reduction and symptoms,” the researchers concluded.

—Michael Potts


Reddel HK, Busse WW, Pedersen S, et al. Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study [published online November 29, 2016]. Lancet. doi: