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. 1998 Jul;79(1):12–17. doi: 10.1136/adc.79.1.12

Treatment of acute asthmatic exacerbations with an increased dose of inhaled steroid

J Garrett 1, S Williams 1, C Wong 1, D Holdaway 1
PMCID: PMC1717626  PMID: 9771245

Abstract

OBJECTIVE—To investigate the efficacy of an increased dose of inhaled steroid used within the context of an asthma self management plan for treating exacerbations of asthma.
DESIGN—Randomised, double blind, placebo controlled, crossover trial.
METHODS—Twenty eight children aged 6-14 years with asthma of mild to moderate severity were studied for six months. Eighteen pairs of exacerbations were available for analysis, during which subjects took an increased dose of inhaled steroids or continued on the same dose.
RESULTS—There was no significant difference between increasing inhaled steroids or placebo on morning or evening peak expiratory flow rates (PEFRs), diurnal peak flow variability, or symptom scores in the two weeks following an asthma exacerbation. Difference (95% confidence intervals) in baseline PEFR on days 1-3 were 3.4% (−3.5% to 10.4%) and −0.9% (−4.7% to 2.9%) for inhaled steroid and placebo, respectively. Spirometric function and the parents' opinion of the effectiveness of asthma medications at each exacerbation were also not significantly different between inhaled steroid or placebo.
CONCLUSION—This study suggests that increasing the dose of inhaled steroids at the onset of an exacerbation of asthma is ineffective and should not be included in asthma self management plans.



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Selected References

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

  1. Asher M. I., Toop L., Mitchell E. A. Asthma in children: consensus on preventive management in New Zealand. N Z Med J. 1994 Mar 23;107(974):108–110. [PubMed] [Google Scholar]
  2. Barnes N. C. Effects of corticosteroids in acute severe asthma. Thorax. 1992 Aug;47(8):582–583. doi: 10.1136/thx.47.8.582. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. 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]
  4. Charlton I., Antoniou A. G., Atkinson J., Campbell M. J., Chapman E., Mackintosh T., Schapira D. Asthma at the interface: bridging the gap between general practice and a district general hospital. Arch Dis Child. 1994 Apr;70(4):313–318. doi: 10.1136/adc.70.4.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Connett G., Lenney W. Prevention of viral induced asthma attacks using inhaled budesonide. Arch Dis Child. 1993 Jan;68(1):85–87. doi: 10.1136/adc.68.1.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. D'Souza W., Burgess C., Ayson M., Crane J., Pearce N., Beasley R. Trial of a "credit card" asthma self-management plan in a high-risk group of patients with asthma. J Allergy Clin Immunol. 1996 May;97(5):1085–1092. doi: 10.1016/s0091-6749(96)70262-2. [DOI] [PubMed] [Google Scholar]
  7. Davies B. A comparison of beclomethasone dipropionate and budesonide in the treatment of asthma. Br J Clin Pract. 1993 Mar-Apr;47(2):87–93. [PubMed] [Google Scholar]
  8. Garrett J., Williams S., Wong C., Holdaway D. Application of asthma action plans to childhood asthma: a national survey. N Z Med J. 1997 Aug 22;110(1050):308–310. [PubMed] [Google Scholar]
  9. Gillies J., Barry D., Crane J., Jones D., MacLennan L., Pearce N., Reid J., Toop L. A community trial of a written self management plan for children with asthma. Asthma Foundation of NZ Children's Action. N Z Med J. 1996 Feb 9;109(1015):30–33. [PubMed] [Google Scholar]
  10. Kerrebijn K. F. Use of topical corticosteroids in the treatment of childhood asthma. Am Rev Respir Dis. 1990 Feb;141(2 Pt 2):S77–S81. [PubMed] [Google Scholar]
  11. Lahdensuo A., Haahtela T., Herrala J., Kava T., Kiviranta K., Kuusisto P., Perämäki E., Poussa T., Saarelainen S., Svahn T. Randomised comparison of guided self management and traditional treatment of asthma over one year. BMJ. 1996 Mar 23;312(7033):748–752. doi: 10.1136/bmj.312.7033.748. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Levy M. L., Stevenson C., Maslen T. Comparison of short courses of oral prednisolone and fluticasone propionate in the treatment of adults with acute exacerbations of asthma in primary care. Thorax. 1996 Nov;51(11):1087–1092. doi: 10.1136/thx.51.11.1087. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Svedmyr J., Nyberg E., Asbrink-Nilsson E., Hedlin G. Intermittent treatment with inhaled steroids for deterioration of asthma due to upper respiratory tract infections. Acta Paediatr. 1995 Aug;84(8):884–888. doi: 10.1111/j.1651-2227.1995.tb13786.x. [DOI] [PubMed] [Google Scholar]
  14. Wilson N. M., Silverman M. Treatment of acute, episodic asthma in preschool children using intermittent high dose inhaled steroids at home. Arch Dis Child. 1990 Apr;65(4):407–410. doi: 10.1136/adc.65.4.407. [DOI] [PMC free article] [PubMed] [Google Scholar]

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