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Letters to the editor
Inhaled corticosteroid dosage in asthma
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  1. H K Reddel1,
  2. G B Marks1,
  3. C M Salome1,
  4. C R Jenkins1
  1. 1Institute of Respiratory Medicine, Camperdown, NSW 2050, Australia; hkr@mail.med.usyd.edu.au

https://doi.org/10.1136/thorax.57.9.837-b

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    We would like to congratulate Ward and colleagues1 on their very important study which showed that significant changes in airway basement membrane thickness in asthma were not observed until after 3 months of treatment with high dose inhaled corticosteroids (ICS), by which time maximum improvement in lung function and airway inflammation had already occurred.

    The authors remind us that current guidelines advocate titration of ICS dosages against symptoms and spirometric data, and express their concern that, under these guidelines, ICS treatment would have been stepped down at 3 months, before the maximal benefit in airway hyperresponsiveness (AHR) and airway remodelling had been achieved. However, we have shown in a long term study of inhaled budesonide2 that AHR continued to improve over an 18 month period even while the ICS dose was being down-titrated. In this study AHR improved by a mean of 3.1 doubling doses after 4 months of high dose budesonide treatment, with a further 1.6 doubling dose improvement over 14 months of ICS …

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