Two studies look at the effect of increasing the dose of inhaled corticosteroids 4 and 5 times to abort asthma deterioration. The results may surprise you.
If a Double Dose Doesn't Do It, is More ICS Safe? Guidelines recommend short-term increased ICS dose for early signs of asthma exacerbation, but there is evidence that doubling the dose may not be enough to prevent deterioration.
Quadrupling ICS Dose in Adults/Teens. Study compared 12 months of personalized management plus either no dose increase at first signs of exacerbation or quadrupling the dose temporarily.
Severe Exacerbations Reduced with 4X ICS Dose. There was a 19% lower risk of time to first exacerbation in the group that used a quadrupled ICS dose vs the group that didn't. Rates of hospitalization were lower in the quadrupling group.
Quintupling ICS Dose in Children. 254 children age 5-11 y with mild to moderate persistent asthma on daily ICS. At first signs of loss of asthma control, randomized to continued low dose ICS or quintupled (5x) ICS dose for 7 days.
No Differences Seen with 5X ICS Dose. No significant differences were seen between patients who continued with their original dose of ICS and those who quintupled the dose in: severe asthma exacerbations, time to the first exacerbation or urgent care visits, treatment failure, or symptom burden.
Clinical Implications. Safety data may support quadrupling ICS dose in adults/teens to abort asthma exacerbation but not quintupling the dose in school-aged children.
Take Home Points. A randomized open-label trial in teens/adults found quadrupling ICS dose upon deterioration in asthma control resulted in fewer exacerbations/asthma hospitalizations than not increasing the ICS dose. And, a randomized double-blind trial in US school-age children showed quintupling ICS dose upon deterioration in asthma control did not improve asthma control and may affect growth.
What is the impact on asthma deterioration of temporarily increasing the dose of inhaled corticosteriods by as much as 5 times the maintenance dose? Two recent studies are highlighted in this short slide show; the results may surprise you.References 1. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention 2017. Accessed March 13 2018 at:2. Kew KM, Quinn M, Quon BS, et al. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2016;7:CD007524. doi: 10.1002/14651858.CD007524.pub4.3. McKeever T, Mortimer K, Wilson A, et al. Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations. N Engl J Med. 2018;378:902-910. doi: 10.1056/NEJMoa1714257.4. Jackson DJ, Bacharier LB, Mauger DT, et al. Quintupling inhaled glucocorticoids to prevent childhood asthma exacerbations. N Engl J Med. 2018;3780):891-901. doi: 10.1056/NEJMoa1710988.