Antiinflammatory therapy with inhaled budesonide is an effective first-line treatment for patients with newly detected, mild asthma, and it is superior to the use of terbutaline in such patients.

Early treatment with inhaled budesonide results in long-lasting control of mild asthma. Maintenance therapy can usually be given at a reduced dose, but discontinuation of treatment is often accompanied by exacerbation of the disease.

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Objective-To compare the efficacy of self management ofasthma with traditional treatment.Design-12 month prospective randomised trial. Setting-Outpatient clinics in Finland. Subjects-115 patients with mild to moderately severe asthma.Interventions-Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements.Main outcome measures-Unscheduled admissions to hospital and outpatient visits, days off work, courses of antibiotics and prednisolone, lung function, and quality oflife.Results-The mean number of unscheduled visits to ambulatory care facilities (0 5 higher in the self management group than in the traditionally treated group. In both groups admissions for asthma were rare. Conclusions-Self management reduces incidents caused by asthma and improves quality oflife. IntroductionDeaths from asthma have been associated with underestimation of its severity, delays in starting treatment in exacerbations, and unsatisfactory routine management and treatment of asthma.' 2 Potentially preventable factors are common in deaths from asthma, and 73% of admissions to hospital for acute asthma could be avoided with proper prior medical care.'3 At least 40% of people with asthma do not react appropriately when symptoms of asthma worsen and over half of the patients admitted with acute asthma have had alarming symptoms for a week before admission.45 In its study of deaths due to asthma in the early 1 980s the British Thoracic Association recommended that patients should measure their own peak flow rates and treat deteriorating symptoms

Adjustable maintenance dosing with budesonide/formoterol provides more effective asthma control by reducing exacerbations and reliever medication usage compared with fixed-dose salmeterol/fluticasone.