Quadrupling Inhaled Steroids May Abort Some Asthma Attacks

MedicalResearch.com Interview with:
“Asthma Inhaler” by NIAID is licensed under CC BY 2.0Timothy Harrison, MBBS, BSc, FRCP, MD, MSc
Professor and Honorary Consultant
Faculty of Medicine & Health Sciences
University of Nottingham

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Self management plans are recommend for patients with asthma but previous studies have shown that doubling the dose of inhaled steroids when asthma starts deteriorating is ineffective at preventing the development of an exacerbation.

This study shows that quadrupling the dose is effective and in a real-life setting can reduce severe exacerbations by about 20%

MedicalResearch.com: What should readers take away from your report?

Response: If physicians want to recommend a temporary increase in inhaled steroid dose when asthma is deteriorating a four-fold increase should be recommended. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: I think a real-life paediatric study is required and in adults we need better ways of identifying who is at greatest risk of exacerbations. 

MedicalResearch.com: Is there anything else you would like to add? 

Response: Only when comparing the two studies I think both have strengths and weaknesses and unfortunately the editorial failed to highlight any of the weakness of the paediatric study such as artificially high adherence and generally mild asthma and exacerbations. Maybe this is why they failed to see an effect.


Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations
Tricia McKeever, Ph.D., Kevin Mortimer, Ph.D., Andrew Wilson, M.D.,
Samantha Walker, Ph.D., Christopher Brightling, Ph.D., Andrew Skeggs, B.Sc., Ian Pavord, F.Med.Sci., David Price, F.R.C.G.P.,, Lelia Duley, M.D., Mike Thomas, Ph.D., Lucy Bradshaw, M.Sc., Bernard Higgins, Ph.D., et al.
March 8, 2018
N Engl J Med 2018; 378:902-910
DOI: 10.1056/NEJMoa1714257

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Last Updated on March 9, 2018 by Marie Benz MD FAAD