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.
- inhaled corticosteroids
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AstraZeneca Canada Inc financially supported this research.
Participating investigators and sites in addition to listed authors: L-P Boulet, Ste-Foy (Québec), J-L Malo, Montréal (Québec), S Blackie, New Westminster, BC; R Olivenstein, Montréal (Québec), P-P Ernst, Montréal (Québec), K Chapman, Toronto, ON; A McIvor, Toronto, ON; S Spier, Calgary, AB; M Yeung, Vancouver, BC.
J M FitzGerald, A Becker, M Yeung, R Olivenstein, and P-P Ernst were on the study steering committee and participated in the design of the trial. J M FitzGerald, A Becker, S Mink, M Sears, K Chung, and J Lee were involved with drafting the protocol and manuscript.
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