Bronchodilators v Inhaled Steroids

The cornerstone of asthma management and measurement of control is the lung function test. As people age there is normally a reduction in lung function, but in asthmatics this decline is accelerated.(1) This is important for two reasons:

1. A decline in lung function is considered to be an indicator that asthma is getting worse
2. People with low lung function tests are more likely to die of asthma.(2)

Therefore logically, any treatment that increases lung function is considered useful in the treatment of asthma. While bronchodilators may increase lung function immediately after taking a puff, no bronchodilator has been shown to slow the expected annual decline in lung.(3) On the other hand, adding inhaled corticosteroids seems to slow this accelerated reduction in lung function in asthmatics.(4)

Based on this information, the question we should ask ourselves is this: why does the Asthma Council of Australia recommend that moderate persistent or severe persistent asthmatics to take at least one daily dose of a bronchodilator every day in the form of Serevent, Oxis or Foradil?(5)

  1. http://www.ncbi.nlm.nih.gov/pubmed/16085937 28/7/10
  2. http://erj.ersjournals.com/cgi/content/full/30/3/411 28/7/10
  3. http://www.australianprescriber.com/magazine/26/2/33/5/ COPD 28/7/10
  4. http://www.annals.org/content/118/10/770.abstract 28/7/10
  5. Asthma Management Handbook. National Asthma Council of Australia. 2006. page 10