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Treatment of acute asthmatic exacerbations with an increased dose of inhaled steroid
J Garrett1, S Williams, C Wong
1Department of Paediatrics and Child Health, Dunedin School of Medicine, University of Otago Medical School, New Zealand.
Insights
Increasing inhaled steroid dosage for asthma exacerbations did not improve lung function or symptoms. This approach is ineffective and should not be part of asthma self-management plans.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Trials
Background:
- Asthma exacerbations are common in children and require effective management.
- Current asthma self-management plans often include adjustments to medication.
- The role of increasing inhaled steroid doses during exacerbations needs clarification.
Purpose of the Study:
- To evaluate the effectiveness of a higher dose of inhaled steroids for managing asthma exacerbations in children.
- To determine if increased inhaled steroid use improves outcomes compared to a stable dose during exacerbations.
Main Methods:
- A randomized, double-blind, placebo-controlled, crossover trial was conducted.
- Twenty-eight children (6-14 years) with mild to moderate asthma participated over six months.
- Eighteen pairs of exacerbations were analyzed, comparing increased inhaled steroids versus a stable dose.
Main Results:
- No significant differences were observed in peak expiratory flow rates, diurnal peak flow variability, or symptom scores between the two groups.
- Spirometric function and parental assessment of medication effectiveness also showed no significant variations.
- The study found no benefit in increasing inhaled steroid doses during asthma exacerbations.
Conclusions:
- Increasing inhaled steroid dosage at the onset of an asthma exacerbation is ineffective.
- This strategy should not be incorporated into asthma self-management plans for children.
- Current evidence does not support the use of increased inhaled steroids for acute asthma symptom management.
Objective:
To investigate the efficacy of an increased dose of inhaled steroid used within the context of an asthma self management plan for treating exacerbations of asthma.
Design:
Randomised, double blind, placebo controlled, crossover trial.
Methods:
Twenty eight children aged 6-14 years with asthma of mild to moderate severity were studied for six months. Eighteen pairs of exacerbations were available for analysis, during which subjects took an increased dose of inhaled steroids or continued on the same dose.
Results:
There was no significant difference between increasing inhaled steroids or placebo on morning or evening peak expiratory flow rates (PEFRs), diurnal peak flow variability, or symptom scores in the two weeks following an asthma exacerbation. Difference (95% confidence intervals) in baseline PEFR on days 1-3 were 3.4% (-3.5% to 10.4%) and -0.9% (-4.7% to 2.9%) for inhaled steroid and placebo, respectively. Spirometric function and the parents' opinion of the effectiveness of asthma medications at each exacerbation were also not significantly different between inhaled steroid or placebo.
Conclusion:
This study suggests that increasing the dose of inhaled steroids at the onset of an exacerbation of asthma is ineffective and should not be included in asthma self management plans.