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Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations
  1. J M FitzGerald1,
  2. A Becker2,
  3. M R Sears3,
  4. S Mink4,
  5. K Chung5,
  6. J Lee5,
  7. and the Canadian Asthma Exacerbation Study Group
  1. 1Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
  2. 2Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
  3. 3Department of Medicine, McMaster University and Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Canada
  4. 4Section of Respiratory Medicine, GF221 Health Sciences Centre, Winnipeg, Canada
  5. 5AstraZeneca Canada Inc, Mississauga, Canada
  1. Correspondence to:
    Dr J M FitzGerald
    Centre for Clinical Epidemiology and Evaluation, VGH Research Pavilion, 822 West 10th Avenue, Vancouver, BC, V5Z 1L8, Canada;


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.

  • asthma
  • exacerbations
  • inhaled corticosteroids
  • dosage

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