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Early intervention with high-dose inhaled corticosteroids for control of acute asthma exacerbations at home and improved outcomes: A randomized controlled trial

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Various studies have examined the efficacy of a temporary increase in the dose of inhaled corticosteroids (ICSs) during acute asthma exacerbations with conflicting results. This study was designed to investigate the efficacy of high-dose ICSs in controlling asthma exacerbations in children. Data were collected on asthmatic children, aged 2‐17 years, who were maintained on ICSs. Participants were randomly assigned to a 12-day treatment protocol for acute asthma exacerbation at doses of ICS that were two, four, or eight times their maintenance ICS dose. The primary outcome was the frequency of need to progress to systemic steroid therapy. The secondary outcome was difference in symptom scores among the three treatment groups to determine if one dosing protocol was superior to another. Eighty-two of 197 enrolled patients experienced acute asthma exacerbation and completed the increased dosing protocol. No significant difference in systemic corticosteroid use was detected between patients treated with two, four, or eight times their maintenance dose of ICS, but we observed a trend toward a larger reduction in mean total symptom score with increasing ICS dose at the end of the study. We did not observe a significant difference in need for systemic corticosteroids between doubling the maintenance dose and increasing to four or eight times the dose, but we observed a trend suggesting that higher doses may improve symptoms better than doubling the dose. A more specific design may be needed to provide a more reliable answer to this question.

Keywords: Asthma; exacerbations; high-dose inhaled corticosteroids; oral corticosteroids

Document Type: Research Article


Affiliations: Marshfield Clinic/Ministry St. Joseph’s Hospital, Marshfield, Wisconsin, USA

Publication date: November 1, 2012

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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