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Quadrupling or quintupling inhaled corticosteroid doses to prevent asthma exacerbations: the jury’s still out
  1. Amanda Jane Friend1,2
  1. 1 Department of Paediatrics, Leeds General Infirmary, Leeds, UK
  2. 2 School of Medicine, University of Leeds, Leeds, UK
  1. Correspondence to Dr Amanda Jane Friend, Department of Paediatrics, Leeds General Infirmary, Leeds, LS1 3EX, UK; amanda.friend{at}nhs.net

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Study 1

Study design

Double blind, randomised controlled trial.

Study question

Setting: UK.

Patients: 1871 adults and adolescents (mean age 57 years) who had a diagnosis of asthma, were being treated with inhaled corticosteroid (ICS) and had had at least one exacerbation requiring systemic glucocorticoid treatment in the preceding 12 months.

Intervention: Quadrupling dose of ICS at the early loss of asthma control (vs usual dose of ICS; both groups increased bronchodilator as required).

Outcomes: Rates of asthma exacerbation requiring treatment with systemic glucocorticoids or an unscheduled healthcare visit.

Main results

The study’s main results are summarised in table 1.

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Table 1

Summary of asthma exacerbations in patients treated with quadrupled dose of ICS vs usual-dose ICS during the 12-month trial period

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Conclusion

Temporary quadrupling of ICS dose at the early signs of loss of asthma control results in a lower rate of severe asthma …

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