INCREASING INHALED STEROIDS FOR ASTHMA EXACERBATIONS

The prevention of asthma exacerbations is a major goal in the management of asthma. Asthma guidelines have suggested that doubling the dose of inhaled steroids at the time of worsening asthma may treat or prevent the worsening of an asthma exacerbation. However, there is little evidence for this approach. In this issue of Thorax FitzGerald and colleagues report a randomised double blind controlled trial to determine whether doubling the dose of inhaled budesonide at the time of an asthmatic exacerbation or continuing with the usual maintenance dose has a beneficial effect on progression to a more severe exacerbation. The authors found that there was no difference in treatment failure (courses of systemic steroids, unscheduled physician visits) between the two groups. This suggests that doubling the maintenance dose of inhaled steroid does not change the pattern of the exacerbation. In the accompanying editorial, Busse and …