Increasing inhaled steroid dose in asthma exacerbations

Ever since inhaled corticosteroids (ICS) were first introduced as an effective prophylactic agent, there has been a debate over whether asthma exacerbations can be treated by increasing the dose. In theory, as we know systemic steroids are highly effective, they should work. A popular strategy is doubling the dose at the first sign of an exacerbation (sometimes termed the ‘yellow zone’), but trials have not shown this to be effective. Could increasing the dose by a factor of four or five work better?

The NEJM recently published two trials side-by-side addressing this question, which came to opposing conclusions. The first, from multiple sites in the United States, was a double-blind placebo-controlled randomised trial involving over 250 children aged 5–11 years (Jackson D et al doi: 10.1056/NEJMoa1710988). All had ‘moderate’ asthma and were on fluticasone 88 µg twice daily at the outset. There were specific criteria for deterioration into the ‘yellow...

from Archives of Disease in Childhood current issue https://ift.tt/2wMKscL