Inpharma 1422 - 31 Jan 2004

Inhaled corticosteroids: doubleddoses of little value in asthma

There is little evidence to recommend doubling thedose of inhaled corticosteroids when asthma controlstarts to deteriorate, according to the results of a UK-based study.

The randomised controlled trial involved 390 primary-care patients (aged ≥ 16 years) with asthma who wereregularly taking an inhaled corticosteroid(100–2000 µg/day) and who had temporarily doubledtheir dose or received oral corticosteroids over theprevious year to treat or prevent an asthmaexacerbation. Patients received corticosteroids todouble their usual dose (n = 192) or placebo,administered via inhalers, in addition to their usualtreatment for 14 days if their asthma deteriorated.* A10-day course of prednisolone was started if theirasthma control deteriorated to the point where theynormally commence oral corticosteroids, or if their peakflow decreased by 40% from the mean run-in value. Theprimary endpoint of the study was the proportion ofpatients who required prednisolone in each studygroup.

Over a 12-month period, the study inhaler was usedby 110 patients in the active group and 97 in the placebogroup. Of these, 19 patients (17%) in the active groupand 22 patients (23%) in the placebo group startedprednisolone treatment (risk ratio 0.8; 95%CI 0.45–1.4). Doubling the dose of inhaledcorticosteroid resulted in a small reduction in the meanmaximum fall in peak flow of –10 L/minute comparedwith placebo (p = 0.07); however, there were nobetween-group differences in the rise in symptomscores, time to recovery for peak flow and symptomscores, lowest peak flow recorded or highest symptomscore recorded. Similar results were observed in asubgroup of patients receiving lower doses of inhaledcorticosteroids (≤ 1000 µg/day).* if their daytime score increased by one point from the mean peakflow and median symptom score during a 2-week run-in period, ortheir morning peak flow fell by 15%

Harrison TW, et al. Doubling the dose of inhaled corticosteroid to prevent asthmaexacerbations: randomised controlled trial. Lancet 363: 271-275, No. 9405, 24 Jan2004 800943986

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Inpharma 31 Jan 2004 No. 14221173-8324/10/1422-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved