The report in the New England Journal of Medicine supports the concept of "stepping down" therapy to reduce risk of long-term side effects from potent medications used to get asthma under control in the first place, doctors suggested.

The study involved 500 patients who had controlled their asthma on twice-daily doses of the inhaled corticosteroid fluticasone Flovent Diskus.

The researchers assigned 169 subjects to remain on that regimen, while assigning 165 patients to receive one daily dose of Advair Diskus (fluticasone plus salmeterol), and the remaining 166 patients to receive a once-daily dose of Singulair (montelukast).

GlaxoSmithKline funded the study along with a grant from the American Lung Association.

"About 20 percent of patients assigned to receive continued (Flovent) or switched to (Advair) had treatment failure, compared with 30.3 percent of patients switched to (Singulair)," said Stephen Peters, professor of medicine and pediatrics at Wake Forest University Health Sciences in Winston-Salem, N.C., who wrote the report on behalf of the researchers who performed the study for the American Lung Association Asthma Clinical Research Centers.

Even though the study found that (Singulair) was not as effective as the other two agents, Peters told United Press International that "the percentage of days on which patients were free of asthma symptoms was similar across the three groups -- ranging from 78.7 percent to 85.8 percent."

"Those differences aren't significantly different," he said. "This study tells patients and physicians that they have a choice in deciding what asthma medicine to use. If a person doesn't want to be on twice daily dosing, that person can use one of the other treatments."

About 10 million people in the United States have mild persistent asthma and would fall into the study group, said Elliot Israel, associate professor of medicine at Brigham and Women's Hospital/Harvard Medical School in Boston.

Israel told UPI, "The study indicates that you can get good asthma control using less of the corticosteroid treatments. However, I would not hesitate to use the twice-daily treatment of inhaled corticosteroids if warranted."

He said that side effects of inhaled corticosteroids include slightly increase risks of cataract formation, glaucoma and osteoporosis. He emphasized that the risk with the inhaled asthma medication is far less than seen with oral systemic steroids.

In Peters' study, patients were treated for fours weeks with twice daily Flovent to make sure their asthma was under control and then were assigned to one of the three treatments and were followed for 16 weeks.

The indication for treatment failure was a composite of several conditions, but Peters said the most important concept to patients is days free of asthma, and all three treatments were about the same in that respect.

Despite being marginally less effective than the other treatments, Peters said patients might want to take Singulair if they have rhinitis and asthma because the drug is indicated for both conditions.

His article was accompanied by a second study undertaken by Italian researchers who tested whether treatment with as-needed medication was effective in treating mild asthma.

In the double-blind study that included 455 patients, Alberto Papi of the University of Ferrara and colleagues said the results of the six-month study suggested that using inhalers when asthma symptoms emerge is as successful in preserving lung function as twice-daily corticosteroid treatment, and the as-needed treatment required less overall use of steroids.

Israel told UPI that the Papi study could become a standard of treatment in the future as doctors and patients seek to individualize treatment. He was one of three authors who wrote commentaries based on both studies that also appeared in the journal.

"We are moving towards personalized treatment in asthma," said Peters.