Increased Versus Stable Doses of Inhaled Corticosteroids for Exacerbations of Chronic Asthma

Summary

A Cochrane review [Abstract] 1 included 8 studies with a total of 1 669 subjects (422 children and 1 247 adults) with mild to moderate asthma. Six were parallel-group trials and 2 had a cross-over design. All but one study followed participants for 6 months to one year. Allowed maintenance doses of inhaled corticosteroid (ICS) varied in adult and paediatric studies, as did use of concomitant medications and doses of ICS initiated during exacerbations. Participants were given a study inhaler containing additional ICS or placebo to be started as part of an action plan for treatment of exacerbations.

There was no significant reduction in the need for rescue oral corticosteroids when patients were randomised to the increased ICS compared to stable maintenance dose groups (table T1). There were no differencies in unscheduled physician visits (OR 0.96, 95% CI 0.66 to 1.41; 3 studies, n=931) or acute visits (Peto OR 0.98, 95% CI 0.24 to 3.98; 3 studies, n=450) between increased versus stable dose of ICS. Serious adverse events (table T1) and non-serious adverse events, such as oral irritation, headaches and changes in appetite (OR 2.15, 95% CI 0.68 to 6.73; 2 studies, n=142), were not significantly different between the groups.