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New Research - October 2009
Increasing the dose of inhaled steroids to manage asthma exacerbations
Summary
The investigators involved in this research project wished to see whether quadrupling the dose of inhaled corticosteroid upon detecting diminishing asthma control would reduce exacerbations requiring oral corticosteroid treatment. To do this, they evaluated 403 individuals with asthma who were given a self-management plan and were randomized to take either active or placebo corticosteroid inhaler therapy. The additional therapy or placebo was administered along with their usual asthma treatment when peak expiratory flow (PEF) fell on two consecutive days by 15% or when it fell by 30% on a single day. Eighteen (9%) of the 197 patients in the active group had an exacerbation requiring treatment with oral corticosteroids. Twenty-nine of 203 (14%) participants in the placebo group had an exacerbation requiring oral corticosteroids. Of the 94 participants who started the study inhaler, fewer required treatment with oral corticosteroids in the active group compared with the placebo group. Twelve of 56 (21%) in the active group, and 19 of 38 (50%) in the placebo group who actually started their inhalers required oral corticosteroids. This gave a risk ratio of 0.43% - CI, 0.24-0.78 - p=0.004.
The primary outcome did not reach statistical significance, but quadrupling the dose of inhaled corticosteroid when asthma control starts to deteriorate appeared to reduce acute exacerbations of asthma. The authors concluded that this therapy deserves further investigation.
Reference
Oborne J, et al. Quadrupling the dose of inhaled corticosteroid to prevent asthma exacerbations: a randomized, double-blind, placebo-controlled, parallel-group clinical trial. American Journal of Respiratory and Critical Care Medicine 2009; 180(5):598-602.
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