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Steroid use disputed for mild asthma

Patients with mild asthma who ignore their doctor's advice to take steroids to prevent attacks, waiting instead to use an inhaler when they need it, are doing the right thing, researchers said yesterday.

The study of 225 adults, published in the New England Journal of Medicine, found that volunteers who took placebos seemed to do just as well as those who regularly took steroids.

While warning that patients should not self-prescribe medication, some specialists said the study showed a way to save money.

All the patients had mild, persistent asthma, which meant their wheezing, coughing, or chest tightness occurred only two to six days a week or the condition woke them up more than two nights a month.

The findings do not apply to the 16 million people whose asthma is more severe. More than 20 million Americans have asthma.

For those with mild, persistent asthma, current guidelines from the National Asthma Education and Prevention Program recommend daily steroids to prevent symptoms and quick-relief medication via a bronchodilator to treat acute asthma symptoms.

''Our findings suggest that the [National Institutes of Health] guidelines for treating asthma may have gone a little too far in requiring patients with truly mild asthma to take these anti-inflammatory drugs every day," chief author Dr. Homer Boushey of the University of California at San Francisco said.

Boushey said most patients with mild asthma who are given steroid prescriptions stop taking the drugs, because they do not seem to provide an immediate benefit or because they worry about side effects.

''Our study shows that for mild asthma, at least for the short term, this 'folk wisdom' is a safe practice," he said in a statement.

The current guidelines, developed in 1997, are expected to be updated next year.

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