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START study 5-year follow-up: effectiveness of early intervention with budesonide in mild persistent asthmaWilliam W Busse, MD, Søren Pedersen, MD, Romain A Pauwels, MD, Wan C Tan, MD, Yu-Zhi Chen, MD, Carl Johan Lamm, PhD, Paul M O’Byrne, MD The 5-Year Inhaled Steroid Treatment As Regular Therapy in Early Asthma (START) study was designed to determine the long-term value of starting inhaled corticosteroids (ICS) early in adults and children with mild persistent disease of less than 2 years’ duration. START enrolled 7241 patients aged 5–66 years with recent-onset, mild persistent asthma to study the effects of early introduction of inhaled corticosteroid budesonide therapy on long-term asthma control. Drawing on data from 32 countries, the authors had previously reported on the double-blind phase of the study. That 3 year phase of START was followed by 2 years of open-label treatment, during which all patients received budesonide once daily while they continued their usual asthma therapy. The authors have now analyzed the results from the full 5 years of study treatment for lung function and asthma control and saw that although early intervention with ICS did not affect lung function, early use of inhaled budesonide was associated with improved asthma control and less additional asthma medication use. There were fewer severe asthma related events, breakthrough symptoms, sleep disturbances, and activity limitations. The clinical benefits of regular treatment with low dose ICS in mild persistent asthma have also been assessed in the Childhood Asthma Management Program (CAMP) and the Prevention of Early Asthma In Kids (PEAK) studies. Both studies showed that low dose ICS in mild persistent asthma significantly improved asthma control, and resulted in fewer hospitalizations, fewer urgent visits to a caregiver, fewer courses of prednisone, and fewer days when patients needed to add on more medication. In this sense the benefits associated with inhaled corticosteroid use are similar to those seen in START. However, the CAMP study was not an early intervention study. In the Prevention of Early Asthma in Kids (PEAK) which studied early ICS use for two years the patient population was 2-3 years of age, younger than the children in START In all, results from the START study support current guideline recommendations for the daily use of ICS therapy in adults and children with mild persistent asthma. Early intervention with ICS has the benefit of improving overall treatment effectiveness and reduces the need for more medication to keep asthma under control. |
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