LOMA: Long-Term Management of Asthma
LOMA: Long-Term Management of Asthma
The purpose of this study was to determine whether the use of induced sputum cell counts
 could guide treatment of asthma more effectively than the use of symptoms and breathing
 tests. The main outcomes where the time to the first exacerbation and the number of
 exacerbations.
Airway inflammation is an important component of asthma. It influences other components which
 include symptoms and airway functional (physiological) measurements. It is the primary target
 of treatment. However, it does not correlate closely with symptoms, need for symptomatic
 bronchodilator relief, or the physiological abnormalities. Furthermore, it can be of
 different types. As a result, physicians are poor at recognizing its presence or type. This
 is important because eosinophilic inflammation is responsive to corticosteroid while
 non-eosinophilic is not responsive.

 The most comprehensive non-invasive or relatively non-invasive measurement of airway
 inflammation is by spontaneous or induced sputum cell counts. These are reliable, valid and
 responsive, the qualities of good measurements. They might therefore be clinically useful to
 guide individual treatment. In the present study we investigated this issue. We compared
 their use, in comparison with the use only of symptoms and spirometry, in preventing
 exacerbations of asthma. We chose prevention of exacerbations as the most important clinical
 outcome because these have the greatest impact on patient's quality of life, morbidity and
 healthcare utilization. The study comprised two Phases. In Phase 1, the minimum treatment to
 control sputum eosinophilia (as well as clinical criteria) in the Sputum Strategy, and
 clinical criteria in the Clinical Strategy, were established. In Phase 2, this minimum
 treatment was maintained and patients were seen every 3 momths and at exacerbations. The
 primary outcomes were the relative risk reduction for the occurrence of the first
 exacerbation and the length of time without exacerbation over 18-20 months in Phase 2 of the
 study.
Inclusion Criteria:

 1. History of asthma for at least one year,confirmed objectively.

 2. New or previously reviewed patients where the minimal treatment requirements have not
 been established within the last six months.

 Exclusion Criteria:

 1. Smokers or ex-smokers for less than 6 months with a smoking history of more than 10
 pack years.

 2. Other pulmonary co-morbidity (other than mild or moderate chronic airflow limitation).

 3. Subjects having a co-existing illness that precludes them from the study.

 4. Inability to give informed consent due to mental or legal reasons.

 5. Pregnancy or lactation.

 6. Known non-compliance with medications.