SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

12/20/05

Doubling the dose of inhaled corticosteroids ineffective in acute asthma attacks

Summary
Background - Inhaled corticosteroids (ICS) are a major component in the maintenance controller therapy of persistent asthma (PA). It is commonly recommended to double the maintenance dose of ICS if a patient with PA manifests an acute asthma exacerbation (AAE). But is this approach effective?

Findings - Rice-McDonald et al of the Mater Adult Hospital in Australia studied a group of patients with PA. They compared the effects in mild-moderate AAE of: 1) doubling the maintenance dose of ICS; 2) continuing the maintenance ICS dose or 3) continuing the maintenance ICS dose plus a course of oral steroids.

They found that doubling the ICS dose was no more effective than just continuing the maintenance ICS dose in AAE, with failures to achieve significant improvement in 61% of patients. Such failures were more likely when the dose of inhaled fluticasone was <2000 microgr. In contrast, adding a course of oral steroids was followed by failures to achieve significant improvement in only 26% of patients.

Side effects were more common during the use of oral steroids (53%) than when doubling the ICS dose (42%) and when continuing just the maintenance ICS dose (19%).

Reference
Intern Med J 2005;35:693-8

Editor's Comments
The findings in the study are similar to that reported recently by a group in the UK (Lancet 2004;59:21-5). These UK investigators subsequently found that quadrupling the ICS dose was more successful in reducing bronchial hyper-responsiveness (Thorax 2004;59:21-5).
Addition of an inhaled LABA may confer additional benefit in preventing worsening of asthma into AAE (Thorax 2005;60:730-4).

 

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