Quadrupling Inhaled Steroid Dose to Prevent Asthma Exacerbations

In a 2004 study, doubling the dose of inhaled corticosteroid at the earliest indication of deteriorating asthma control did not prevent full-blown exacerbations (JW Gen Med Feb 10 2004). Now, U.K. researchers have examined the effect of quadrupling the dose in 403 adults who were using conventional doses of inhaled steroids as maintenance therapy.

Patients were randomized to begin using active-treatment inhalers (which quadrupled the total steroid dose when added to the patients' standard inhalers) or placebo inhalers when morning peak expiratory flow fell by 15% on 2 consecutive days or by 30% on a single day. During 12 months of follow-up, the proportions of patients with exacerbations who required oral corticosteroids was 9% in the active…