BEST ADJUSTMENT STRATEGY FOR ASTHMA IN THE LONG TERM (BASALT)

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. People with asthma who have symptoms more than twice a week are advised to use a corticosteroid in an inhaler (beclomethasone, budesonide, or fluticasone, for example) to help control their asthma. In many cases, this treatment results in good control of asthma. Consensus statements suggest that after asthma is controlled, medications may be reduced, and conversely, if asthma then becomes symptomatic again, that medications be increased. However, it is not known what the best way to adjust therapy. Current guidelines base adjustments on many factors, including the frequency of symptoms, and objective measures of lung function. However, these guidelines do not take into consideration the amount of irritation (inflammation) present in the lungs. Most asthma physicians believe that inflammation in the lungs should be controlled, and a new machine that measures eNO, a correlate of inflammation in the lungs, has been approved by the FDA for use in asthma patients. One study has shown some benefit of managing asthma by the use of eNO, but its use has not been compared with other strategies. Finally, a previous ACRN study has shown that patients with mild asthma are as well treated with symptomatic treatment as with regularly scheduled asthma treatment. The purpose of this study is to compare these three approaches to adjusting asthma medications to see which is best over a period of time long enough to be clinically meaningful (36 weeks of intervention; 44 weeks total).