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ASTHMA |
1 Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
2 Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
3 Department of Medicine, McMaster University and Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Canada
4 Section of Respiratory Medicine, GF221 Health Sciences Centre, Winnipeg, Canada
5 AstraZeneca Canada Inc, Mississauga, Canada
Correspondence to:
Correspondence to:
Dr J M FitzGerald
Centre for Clinical Epidemiology and Evaluation, VGH Research Pavilion, 822 West 10th Avenue, Vancouver, BC, V5Z 1L8, Canada; markf{at}interchange.ubc.ca
Background: Previous guidelines recommend doubling the daily dose of maintenance inhaled corticosteroid to treat or prevent progression of exacerbations of asthma.
Methods: Over a 6 month period a cohort of patients were evaluated prospectively and randomised in a double blind controlled trial to treatment with either a continued maintenance dose (MD) of inhaled corticosteroid or doubling the dose (DD) at the time of an exacerbation.
Results: A total of 290 patients were randomised (33% male) and 98 (DD, n = 46) experienced evaluable asthma exacerbations during the study period. Mean (SD) baseline characteristics at randomisation (age 33.5 (14.0) years; forced expiratory volume in 1 second (FEV1) 2.8 (0.7) l; peak expiratory flow (PEF) 422.9 (110.5) l/min) were similar in both groups. In the DD group 41% of patients were considered treatment failures because they either required systemic steroids (n = 12), had an unscheduled visit to a physician (n = 1), or their asthma did not return to baseline (n = 6). This did not differ from the MD group in which 40% were treatment failures (n = 9, 0, and 12, respectively; p = 0.94).
Conclusions: In patients who regularly take an inhaled corticosteroid, doubling the maintenance dose may not affect the pattern of the exacerbation.
Keywords: asthma; exacerbations; inhaled corticosteroids; dosage
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Thorax 2004 59: 545.
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