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From March through May 2018, the New England Journal of Medicine published results of four industry-sponsored, randomized trials in which researchers examined novel ways to use inhaled corticosteroids (ICS) to treat patients whose asthma symptoms worsen, with the goal of preventing major exacerbations. Because these regimens probably are unfamiliar to most primary care clinicians, I will briefly outline the findings and suggest how they might be incorporated into current practice.
Despite little evidence of efficacy, some asthma guidelines and asthma action plans recommend quadrupling the dose of ICS to prevent exacerbations in patients with early worsening asthma symptoms. In two randomi…