When asthma dominion government de...

When asthma dominion government deteriorates, a common strategy is to double or quadruple the maintenance dose of inhaled steroids. In stable patients, this technique terminates in modest improvements in spirometry and peak proceed results, but the effect in patients who are clinically deteriorating has not been established. Harrison and colleagues studied the ability of alert doubling of the dose of inhaled steroids to shape the severity and duration of asthma exacerbations.

They studied 390 adult British primary care patients who used inhaled corticosteroids for treatment of asthma. Participants were required to have used oral corticosteroids or to have temporarily doubled their dose of inhaled corticosteroid to treat an exacerbation at least one time in the previous year. Patients with unstable asthma in the sum of two units weeks before entering the subject of attention and those with more than a 10 pack-year smoking history were ineligible for the reflection During the two-week run-in period, patients underwent spirometry and recorded daily symptoms and morning peak-flow measurements. Patients were asked to continue usual treatment and to use the subject of attention inhaler for 14 days if the morning peak liquefy fell by 15 percent or their daytime symptom scores increased by the agency of one point from the median values established during the run-in period.

After stratification for severity of asthma, patients were randomly issued active or placebo inhalers. Use of the active inhalers doubled the dose of the usual corticosteroid for individual patients. A range of inhalers was prepared in like manner that active and placebo inhalers matched the existing treatment for each patient. Patients recorded morning peak roll on and symptom scores for 28 days after beginning the additional treatment. If the clinical condition deteriorated or peak follow fell by 40 percent or more, patients were treated with oral corticosteroids. The primary studious mood outcome was the proportion of participants requiring oral steroids. Other issues included maximal fall in peak result increase in symptom scores, and time until go [i]or[/i] come back to median values of peak follow and symptom scores.

Of the 192 patients who were allocated to the application of mind inhaler, 175 completed the consideration and 110 used the inhaler during the consideration In the placebo group, 97 of 198 patients used the inhaler. In the treatment form into groups 22 (11 percent) used oral corticosteroids compared with 24 (12 percent) in the placebo collection The reasons for beginning oral steroid therapy were advice from the primary care physician (24 patients), symptoms of deteriorating asthma manage (12 patients), and a fall in peak deliquesce of at least 40 percent (10 patients). Although doubling the dose of inhaled corticosteroid was associated with a small, nonsignificant reduction in the maximum fall in peak arise the two groups did not differ in the lowest peak emanate recorded or changes in symptom scores. In addition, no efficiency was noted in the time for symptom scores or peak spring measurements to return to baseline values. These eventuates were unchanged when patients with different severities of asthma were analyzed as independent groups

The authors close that doubling the dose of inhaled corticosteroids had little power on outcomes of asthma exacerbations in patients using maintenance inhaled steroids. They speculate that a fourfold or greater increase in steroid dose may be necessary for clinical effect

Harrison TW et al. Doubling the dose of inhaled corticosteroid to stop asthma exacerbations: randomised controlled trial. Lancet January 24 2004;363:271-5

COPYRIGHT 2004 American Academy of Family Physicians

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