Doubling of Steroids Before Severe Asthma Attacks Ineffective

Issue 24 January 2004

Recommendations to double inhaled steroids at the start of asthma attacks are challenged by research findings in this week's issue of THE LANCET.

Doubling the dose of inhaled corticosteroid when asthma control deteriorates is widely advocated but is of unproven value. Tim Harrison from the department of respiratory medicine, Nottingham City Hospital, UK, and colleagues studied 390 asthma patients, deemed to be at risk of an asthma exacerbation. Patients monitored their asthma for up to one year and were instructed to add an extra inhaler (either steroid or placebo) for two weeks when their asthma control deteriorated.

There was no statistically significant difference in the proportion of people requiring oral steroids (the main study outcome) between the active and placebo groups (around 12% of patients in both groups).

Tim Harrison comments: "Our findings provide little support for the recommendation that patients taking an inhaled corticosteroid should double the dose when asthma control is deteriorating. Whether a larger increase in inhaled corticosteroid dose would be effective needs to be established. Until more data are available patients should continue to take a short course of oral steroids for asthma exacerbations"

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