Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1996 Nov;51(11):1087–1092. doi: 10.1136/thx.51.11.1087

Comparison of short courses of oral prednisolone and fluticasone propionate in the treatment of adults with acute exacerbations of asthma in primary care.

M L Levy 1, C Stevenson 1, T Maslen 1
PMCID: PMC1090518  PMID: 8958890

Abstract

BACKGROUND: Oral corticosteroids used in short courses for acute asthma are regarded as safe, although the frequent use of these drugs may result in patients suffering from systemic side effects. It has become common practice for patients to increase their own inhaled corticosteroid intake when their asthma goes out of control, but it has never been established whether a high dose of inhaled corticosteroid can be as effective as a short course of oral corticosteroid in the treatment of acute exacerbations. METHODS: A multicentre, randomised, double blind, double dummy, parallel group study was undertaken to determine whether the introduction of a high dose of inhaled fluticasone propionate (2 mg daily) is as effective as a short reducing course of oral prednisolone (starting at 40 mg/day and reducing by 5 mg every other day) in the treatment of acute exacerbations of asthma not considered severe enough for admission to hospital but requiring treatment with oral corticosteroid. RESULTS: Four hundred and thirteen adult asthmatic subjects who presented to their general practitioner with an acute exacerbation of asthma were recruited in 47 general practices in the United Kingdom. Treatment failures, defined as a reduction in peak expiratory flow (PEF) to below 60% of the patient's best/predicted value on two consecutive occasions or persistent symptoms with no improvement on three consecutive days, occurred in 23% of patients who received oral prednisolone and 27% who received inhaled fluticasone propionate (difference in percentage of treatment failures 4.3, 95% CI -4.1 to 12.8, p = 0.31). In each group 48% were classified as treatment successes, defined as a 10% or greater increase in percentage best/predicted morning PEF. Both treatments were equally well tolerated. CONCLUSIONS: There is no evidence of a significant difference in efficacy between a reducing dose course of oral prednisolone and high dose inhaled fluticasone propionate in mild exacerbations of asthma which do not require admission to hospital.

Full text

PDF
1087

Images in this article

1089Image
on p.1089

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beasley R., Cushley M., Holgate S. T. A self management plan in the treatment of adult asthma. Thorax. 1989 Mar;44(3):200–204. doi: 10.1136/thx.44.3.200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bosman H. G., van Uffelen R., Tamminga J. J., Paanakker L. R. Comparison of inhaled beclomethasone dipropionate 1000 micrograms twice daily and oral prednisone 10 mg once daily in asthmatic patients. Thorax. 1994 Jan;49(1):37–40. doi: 10.1136/thx.49.1.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bucknall C. E., Robertson C., Moran F., Stevenson R. D. Management of asthma in hospital: a prospective audit. Br Med J (Clin Res Ed) 1988 Jun 11;296(6637):1637–1639. doi: 10.1136/bmj.296.6637.1637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chapman K. R., Verbeek P. R., White J. G., Rebuck A. S. Effect of a short course of prednisone in the prevention of early relapse after the emergency room treatment of acute asthma. N Engl J Med. 1991 Mar 21;324(12):788–794. doi: 10.1056/NEJM199103213241202. [DOI] [PubMed] [Google Scholar]
  5. Connett G. J., Warde C., Wooler E., Lenney W. Prednisolone and salbutamol in the hospital treatment of acute asthma. Arch Dis Child. 1994 Mar;70(3):170–173. doi: 10.1136/adc.70.3.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Higgins B. G., Britton J. R., Chinn S., Jones T. D., Jenkinson D., Burney P. G., Tattersfield A. E. The distribution of peak expiratory flow variability in a population sample. Am Rev Respir Dis. 1989 Nov;140(5):1368–1372. doi: 10.1164/ajrccm/140.5.1368. [DOI] [PubMed] [Google Scholar]
  7. Jobanputra P., Ford A. Management of acute asthma attacks in general practice. Br J Gen Pract. 1991 Oct;41(351):410–413. [PMC free article] [PubMed] [Google Scholar]
  8. Neville R. G., Clark R. C., Hoskins G., Smith B. National asthma attack audit 1991-2. General Practitioners in Asthma Group. BMJ. 1993 Feb 27;306(6877):559–562. doi: 10.1136/bmj.306.6877.559. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Noonan M., Chervinsky P., Busse W. W., Weisberg S. C., Pinnas J., de Boisblanc B. P., Boltansky H., Pearlman D., Repsher L., Kellerman D. Fluticasone propionate reduces oral prednisone use while it improves asthma control and quality of life. Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 1):1467–1473. doi: 10.1164/ajrccm.152.5.7582278. [DOI] [PubMed] [Google Scholar]
  10. Nunn A. J., Gregg I. New regression equations for predicting peak expiratory flow in adults. BMJ. 1989 Apr 22;298(6680):1068–1070. doi: 10.1136/bmj.298.6680.1068. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. O'Driscoll B. R., Kalra S., Wilson M., Pickering C. A., Carroll K. B., Woodcock A. A. Double-blind trial of steroid tapering in acute asthma. Lancet. 1993 Feb 6;341(8841):324–327. doi: 10.1016/0140-6736(93)90134-3. [DOI] [PubMed] [Google Scholar]
  12. Reid I. R. Pathogenesis and treatment of steroid osteoporosis. Clin Endocrinol (Oxf) 1989 Jan;30(1):83–103. doi: 10.1111/j.1365-2265.1989.tb03730.x. [DOI] [PubMed] [Google Scholar]
  13. Seale J. P., Compton M. R. Side-effects of corticosteroid agents. Med J Aust. 1986 Feb 3;144(3):139–142. [PubMed] [Google Scholar]
  14. Smith R. Corticosteroids and osteoporosis. Thorax. 1990 Aug;45(8):573–578. doi: 10.1136/thx.45.8.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Toogood J. H. Efficiency of inhaled versus oral steroid treatment of chronic asthma. N Engl Reg Allergy Proc. 1987 Mar-Apr;8(2):98–103. doi: 10.2500/108854187778994464. [DOI] [PubMed] [Google Scholar]
  16. Webb J. R. Dose response of patients to oral corticosteroid treatment during exacerbations of asthma. Br Med J (Clin Res Ed) 1986 Apr 19;292(6527):1045–1047. doi: 10.1136/bmj.292.6527.1045. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES