MedWire News: Quadrupling a patient’s dose of inhaled corticosteroids (ICS) when asthma control starts to deteriorate may help reduce their risk for acute exacerbations, study findings suggest.
“Asthma exacerbations are unpredictable, disruptive, and frightening for individuals and have considerable financial implications for health care providers and society,” explain Janet Oborne (University of Nottingham, UK) and colleagues.
They add: “The widespread advice to temporarily double the dose of inhaled corticosteroid was shown to be ineffective at preventing exacerbations in two randomized controlled trials. Whether a more substantial increase in dose of inhaled corticosteroid when asthma control starts to deteriorate would be effective is not known.”
To investigate, the team randomly assigned 403 patients with asthma, aged an average of 54 years, to take a placebo or active corticosteroid inhaler containing a quadruple dose in addition to their usual asthma treatment when their peak expiratory flow (PEF) fell by 15% on 2 consecutive days or by 30% on 1 day. Participants also received an individualized asthma management plan.
In total, 9% of patients in the active inhaler group had an asthma exacerbation requiring treatment with oral corticosteroids compared with 14% of those in the placebo group.
Of the 94 participants who used the active inhaler, far fewer required treatment with oral corticosteroids, at 21% compared with 50% of those using the placebo inhaler. After accounting for age and other variables, treatment with a quadruple dose of inhaled corticosteroid when PEF started to deteriorate was associated with a reduced risk for asthma exacerbations requiring treatment with oral corticosteroids, at a risk ratio of 0.43.
Oborne and team conclude in the American Journal of Respiratory and Critical Care Medicine: “Our trial suggests that providing patients with asthma with a self-management plan incorporating a four-fold increase in dose of inhaled corticosteroid when asthma control starts to deteriorate may be effective at preventing exacerbations.
“A larger, widely inclusive, multicenter clinical trial is now needed to confirm these findings.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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