Mild persistent asthmatic patients constitute a significant proportion of patients (up to 70% of all asthmatics) 1. These patients might be considered the “silent majority” of asthmatics. This is because they rarely visit their primary care physician with symptoms of asthma, and are even more rarely seen in a secondary or tertiary healthcare setting, where physicians with a focused interest in asthma management tend to work. It is partly for this reason that, until recently, very little attention has been paid to the morbidity associated with mild persistent asthma and very few studies have evaluated the responses of this patient population to treatment.
Asthma management guidelines typically describe mild persistent asthma as patients having: asthma symptoms more than weekly, but less than daily, and nocturnal symptoms less than weekly, with normal lung function (forced expired volume in one second (FEV1) or peak expiratory flow >80%) between asthma episodes 2. However, most studies that claim to have studied patients with “mild-to-moderate asthma” have not included many (or any) patients with mild asthma, as reflected by the mean FEV1, which was usually in the range of 70% predicted normal and/or rescue β2-agonist use of 2–3 puffs·day−1 3–5. This makes these studies of little or no value in deciding on treatment strategies for patients with mild persistent asthma. However, there has been an increase in the number of studies focusing on the optimal management of mild persistent asthma, some of which have been published very recently.
CURRENT TREATMENT RECOMMENDATIONS FOR MILD PERSISTENT ASTHMA
Asthma treatment guidelines have been consistent in describing the goals and objectives of asthma treatment. These are to: 1) minimise or eliminate asthma symptoms; 2) achieve the best possible lung function; 3) prevent asthma exacerbations; 4) do the above with the least possible medications; 5) minimise short- and …