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Severe asthma attacks reduced by quadrupling steroids, finds study

Quadrupling the dose of inhaled steroids temporarily when asthma control begins to deteriorate could reduce the risk of a severe asthma attack.

A trial including nearly 2,000 adults and adolescents who were receiving inhaled glucocorticoids found an actual reduction of 19%, which researchers said was significant.

The University of Nottingham team compared two self-management plans, one which included quadrupling the dose of inhaled steroids and one which did not, over 12 months.

Their paper, published in New England Journal of Medicine said that ‘temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate resulted in fewer severe asthma exacerbations than a plan in which the dose was not increased’.

But they admitted that 'the magnitude of reduction was smaller than expected', having set out to see whether incidence could be reduced by 30%.

The researchers noted that there was a higher frequency of treatment-related adverse effects in the quadrupling group, such as oral candidiasis, but no significant between-group difference in the incidence of pneumonia was seen.

Asthma UK director of research and policy Dr Samantha Walker, who co-authored the paper, said the 'groundbreaking' research could 'make a real difference' to patients.

She said: 'This study showed that increasing the steroids in someone’s preventer inhaler could prevent them having severe asthma attacks and needing to go to hospital.

‘We’d urge any healthcare professionals who want to increase their patient’s asthma medication to fully explain what it means, let them know about potential side effects and include it in their written asthma action plan.'

This finding follows previous research from the university, which found that doubling the dose of inhaled steroids during worsening asthma did not prevent the frequency of serious attacks.

Last September, new research from European Respiratory Journal found that older patients who used steroid inhalers were nearly twice as likely to be diagnosed with a lung infection, with that risk increasing with the length of time the steroid was taken.

Readers' comments (3)

  • Since standard 'Asthma Action Plan' includes increasing the dose of inhaled steroids at first signs of an exacerbation or URTI, I am not sure of the merit of a control group which did not follow this basic response.
    It would be more useful to know if quadrupling was more effective than doubling the dose, and at what side-effect cost.

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  • It is important to note that the study was in those over 16y old. The same issue of the NEJM has a paper on quintupling the ICS dose in children aged 5 to 11. This "failed to show a reduction in severe exacurbations or other asthma outcomes and may be associated with diminished linear growth"

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  • Anonymouse3.As the article points out, the same researchers looked at doubling the dose in a previous study and found it ineffective.

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