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Related Experiment Videos

Initial corticosteroid therapy for asthma.

Peter G Gibson1, Heather Powell

  • 1Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New South Wales, and University of Newcastle, Australia. peter.gibson@hnehealth.nsw.gov.au

Current Opinion in Pulmonary Medicine
|December 17, 2005
PubMed
Summary
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For asthma maintenance, initiating inhaled corticosteroids at a moderate, constant dose is recommended. Combining inhaled corticosteroids with long-acting beta2 agonists offers faster symptom and lung function improvement than inhaled corticosteroids alone.

Area of Science:

  • Pulmonology
  • Pharmacotherapy
  • Respiratory Medicine

Background:

  • Asthma pharmacotherapy involves inhaled corticosteroids (ICS) and long-acting beta2 agonists (LABA).
  • Optimal initiation strategies for maintenance therapy remain under investigation.

Purpose of the Study:

  • To review evidence on initiating ICS alone or with LABA for asthma maintenance.
  • To compare different ICS starting doses and regimens.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs).
  • Analysis of studies examining ICS dose (high, moderate, low) and regimen (step-down vs. constant).
  • Review of RCTs on ICS/LABA combination therapy as initial treatment.

Main Results:

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  • No significant difference in outcomes between step-down and constant ICS doses.
  • Moderate-dose ICS showed improvement in peak expiratory flow and nocturnal symptoms compared to low-dose.
  • ICS/LABA combination therapy improved lung function and symptoms faster than ICS alone, but not exacerbations.
  • Escalating ICS/LABA doses showed benefit in uncontrolled asthma.

Conclusions:

  • Initiate asthma maintenance therapy with a constant, moderate ICS dose.
  • ICS/LABA combination therapy provides superior and faster symptom and lung function improvement.
  • Escalating ICS dose strategies may be necessary to reduce exacerbations.