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Evidence summaries

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

Patient-initiated increase in the dose of an inhaled corticosteroid at the onset of an asthma exacerbation appears not to reduce the need for rescue systemic corticosteroids in adults and children with mild to moderate asthma. Level of evidence: "B"

The quality of evidence is downgraded by imprecise results (wide confidence intervals).

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.

Increased compared to stable inhaled corticosteroid (ICS) dose for exacerbations of chronic asthma

OutcomeAssumed risk - Maintenance ICS doseCorresponding risk - Increased ICS doseRelative effect (95% CI)Participants (studies)
Need for rescue oral corticosteroids179 per 1 000163 per 1 000 (129 to 205)OR 0.89(0.68 to 1.18)1 520 (7 studies)
Serious adverse events56 per 1 00091 per 1 000 (44 to 181)OR 1.69(0.77 to 3.71)394 (2 studies)

Clinical comments

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    References

    • 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;(6):CD007524. [PubMed].

Primary/Secondary Keywords