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Increased dose of inhaled corticosteroids did not reduce need for rescue corticosteroids in asthma patients

Ducharme F. Cochrane Database Syst Rev. 2010; doi:10.1002/14651858.CD007524.pub2.

Increasing the dose of inhaled corticosteroids at the time of an asthma attack did not reduce the need for rescue oral corticosteroids, according to data from a meta-analysis. The finding contradicts patient-initiated action plans that have been advocated by several asthma consensus guidelines, according to the researchers.

Francine Ducharme, PhD, of the University of Montreal, and colleagues searched the Cochrane Airways Group Specialized Register and indentified five randomized clinical trials involving 1,222 adults and 28 children with mild-to-moderate asthma. The patients’ average daily dose of inhaled corticosteroids (ICS) was 555 mg (range 200 mg to 795 mg.) The patients were randomly assigned to a higher ICS dose at the start of an asthma exacerbation, or their usual dose. When increased, ICS doses averaged 1,520 mg (range 1,000 mg to 2,075 mg.)

“We wanted to know whether the strategy of increasing the dose of inhaled corticosteroids was safe and effective, compared to continuing the same usual dose of inhaled corticosteroids. If this strategy is not effective, doubling the dose may in fact provide false reassurance,” Ducharme said in a press release. “Moreover, keeping to a constant dose would reinforce the effectiveness of taking daily inhaled corticosteroids, not only during exacerbations and/or encourage the search for more effective strategies.”

The researchers did not observe a significant decrease in the need for rescue oral corticosteroids in patients who increased their ICS dose versus patients who did not. (OR=0.85; 95% CI, 0.58-1.26). There was no significant difference in non-serious adverse events between the two groups, “but the wide confidence interval prevents a firm conclusion,” the authors wrote.

"More pediatric studies are needed to guide treatment of exacerbations. In the meantime, the best approach is to prevent an exacerbation by ensuring regular use of inhaled corticosteroids," Ducharme said in the release.

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