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Quadrupling inhaled steroid dose reduces severe asthma attacks

During worsening asthma control, a self-management plan involving a temporary four-times increase in the dose of inhaled glucocorticoids reduced severe asthma exacerbations, according to research published in The New England Journal of Medicine.

“Although plans for patients to manage their asthma (self-management plans) have been shown to improve asthma control, the previously recommended step of doubling the dose of inhaled glucocorticoids when asthma control is deteriorating is ineffective at preventing acute exacerbations,” Tricia McKeever, PhD, from the department of epidemiology and public health at the University of Nottingham, England, and colleagues wrote.

McKeever and colleagues conducted a trial to determine if a self-management plan that recommends that patients with asthma temporarily quadruple their dose of inhaled glucocorticoids when asthma control begins to decline reduces severe asthma exacerbations compared with usual care.

The researchers enrolled 1,871 adults and adolescents with asthma who were taking inhaled glucocorticoids and who had at least one exacerbation within the past year. Participants were randomly assigned to a self-management plan that included a fourfold increase in the dose of inhaled glucocorticoids or a standard plan without an increase.

The study revealed that after 12 months, fewer patients in the quadrupling group experienced a severe asthma exacerbation than in the usual care group (45% vs. 52%). There was a 20% reduction in severe asthma attacks in the quadrupling group compared with the nonquadrupling group (adjusted HR = 0.81; 95% CI, 0.71-0.92). Fewer asthma-related hospital admissions were observed in the quadrupling group than the nonquadrupling group (3 vs. 18).

“This study showed that increasing the steroids in someone’s preventer inhaler could prevent them having severe asthma attacks and needing to go to hospital,” Samantha Walker, PhD, coauthor from and director of research and policy at Asthma UK, said in a press release.

“We’d urge any health care professionals who want to increase their patient’s asthma medication to fully explain what it means, let them know about potential side effects and include it in their written asthma action plan,” she continued. “People with asthma who would like to increase their medication should talk to their health care professional and should not delay getting help or support even if they do have an asthma attack.” – by Alaina Tedesco

Disclosure: McKeever reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.