A study of nearly 300 patients with mild persistent asthma found that inhaled steroids—long considered the gold standard for asthma treatment—were no more effective than placebo in nearly three-fourths of the study patients, all over age 12. Inhaled steroids were better than placebo for a subset of the patients who had high levels of a particular type of inflammatory cells, called eosinophils, in their sputum, but they represented about a fourth of patients enrolled in the clinical trial (called the Steroids In Eosinophil Negative Asthma (SIENA) trial).
The research highlights the need for developing more effective treatments for asthma and suggests that it may be possible to target particular therapies to subsets of patients, such as those with high or low eosinophils. New approaches to treating the “low eosinophil” group could be especially helpful for improving the overall effectiveness of treatments for mild asthma, the most common type of this respiratory condition. The study, funded by NHLBI, appeared in the New England Journal of Medicine. It was accompanied by an editorial in NEJM.
James Kiley, Ph.D., director of the Division of Lung Diseases at NHLBI, said the research underscored the value of customizing treatments to help people with asthma. “This study adds to a growing body of evidence that different patients with mild asthma should be treated differently, perhaps using biomarkers like sputum eosinophils to select which drugs should be used—a precision medicine approach,” he said.