Best Adjustment Strategy for Asthma in the Long Term (BASALT) study finds no difference in efficacy among asthma medication management methods [JAMA]

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Key study points:

  1. ·The United States’ current standard of care for adjustment of inhaled corticosteroids in asthmatic patients does not differ in efficacy when compared to other adjustment methods
  2. Symptom-based adjustment of asthma medication is proposed as a preferred adjustment method

Primer: Due to symptomatic variability, asthma control inhaled steroids ­­­require monitoring and adjustment when appropriate. These medications are modified according to healthcare provider’s interpretation of a patient’s symptom status, through the use of disease biomarkers, or based on reported regularity of a patient’s symptoms. Physician-based adjustment (PABA) strategies are currently the standard of care in the United States of America. However, no extensive investigation into the efficacy of these methods has been completed. Researchers aimed to determine whether or not one adjustment strategy had lower treatment failure rates in order to optimize the treatment plans of patients with asthma.

This [randomized controlled] study: 342 patients with well or partially controlled, mild to moderate asthma were randomized into one of three groups for inhaled beclomethasone modification: physician PABA guidelines drawn from National Heart, Lung, and Blood Institute recommendations (114), exhaled nitric oxide biomarker-based adjustment (BBA; 115), or symptom-based adjustment according to patient-reported frequency of albuterol use (SBA; 113). Patients in the former two groups were assessed for adjustment every six weeks at clinic visits, while the latter group was adjusted on an “as-needed” basis.

The researchers were primarily interested in the amount of time for patients to reach treatment failure. There was no significant difference in time leading to treatment failure between the three groups with the PABA group having a Kaplan-Meier failure rate at 9 months of 22% (97.5% CI: 14-33%), BBA group with 20% (97.5% CI: 13-30%), and the SBA group 15% (97.5% CI: 9-25%).

In sum: Researchers note that the current standard of care, PABA, is not a lesser method of adjustment when compared to BBA and SBA. However, they propose SBA might be a preferred method for asthma management as it empowers patients while allowing for rapid administration of anti-inflammatory medication when a patient is likely symptomatic secondary to inflammation.

Click to read in JAMA

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