Do Higher Doses of Inhaled Steroids Help with Asthma Exacerbations?

For patients whose asthma symptoms worsen but who do not yet need urgent care visits, the best intervention is unknown. Doubling the dose of inhaled corticosteroids (ICS) is not effective, but current guidelines (e.g., Global Initiative for Asthma) recommend quadrupling the ICS dose when symptoms increase. Researchers examined this recommendation in separate studies in children and adults.

In a blinded study, 254 children with mild-to-moderate asthma who were taking low-dose ICS were randomized to increase their ICS doses fivefold (from 88-μg fluticasone twice daily to 440-μg twice daily for 7 days) or to continue their current ICS doses when asthma symptoms became noticeable (defined as needing 2 doses of albuterol in 6 hours or 3 doses of …