Table 2.
Inhaled Steroid Dosing Adjustment
| Control Status | Inhaler Dose Change | |
|---|---|---|
| Physician assessment-based adjustment (inhaler A)a FEV1 ≥85% at baseline Plus symptoms in past 2 wk ≤2 d/wk (all AEQ scores of 0) |
Well controlled | Down 1 level |
| Plus symptoms no worse than mild (AEQ scores of 0 or 1 on each question) | Controlled | Maintain current level |
| FEV1 <85% at baseline, moderate symptoms (any AEQ score of 2 or 3), or meets criteria for treatment failure |
Undercontrolled | Up 1 level |
| Biomarker-based adjustment (inhaler B) Fraction of exhaled nitric oxide, ppb <22 |
Well controlled | Down 1 level |
| 22-35 | Controlled | Maintain current level |
| >35 | Undercontrolled | Up 1 level |
| Inhaled corticosteroids dose levelb | Dose, μg/d | Frequency |
| 1 | None | |
| 2 | 80 (2 puffs) | Once daily (am) |
| 3 | 160 (2 puffs) | Twice daily |
| 4 | 320 (4 puffs) | Twice daily |
| 5 | 640 (8; 4 puffs at double strength) | Twice daily |
Abbreviations: AEQ, Asthma Evaluation Questionnaire; FEV1, forced expiratory volume in the first second of expiration.
a
Physician was defined as the principal investigator or his/her physician designee, who used a clinical assessment tool similar to the US National Heart, Lung, and Blood Institute guidelines.
b
All participants began the trial at level 3, from which therapy could be intensified or deintensified. The dose level was the prescribed therapy intensity.