High dose versus low dose inhaled corticosteroid as initial starting dose for asthma in adults and children

Abstract

For patients with asthma who require ICS, commencing with a moderate dose ICS is equivalent to commencing with a high dose ICS and down-titrating. The small significant benefits of commencing with a high ICS dose are not of sufficient clinical benefit to warrant its use when compared to moderate or low dose ICS. Initial moderate ICS dose appears to be more effective than initial low ICS dose. High dose ICS may be more effective than moderate or low dose ICS for airway hyperresponsiveness. There is no benefit in doubling or quadrupling ICS in subjects with stable asthma.

Tiotropium Bromide Step-Up Therapy for Adults with Uncontrolled Asthma

“…Although an increase in the dose of an inhaled glucocorticoid by a factor of four has been reported to reduce asthma exacerbations,25 low doses of an inhaled glucocorticoid have been reported to provide a benefit equivalent to that of a high dose with respect to measures of asthma control,26 the outcomes that we studied. In addition, combinations of inhaled glucocorticoids and LABA therapy have been reported to provide superior asthma control, as compared with an increased dose of an inhaled glucocorticoid, even when the dose was more than doubled 27…”

Tiotropium Bromide Step-Up Therapy for Adults with Uncontrolled Asthma

“…Although an increase in the dose of an inhaled glucocorticoid by a factor of four has been reported to reduce asthma exacerbations,25 low doses of an inhaled glucocorticoid have been reported to provide a benefit equivalent to that of a high dose with respect to measures of asthma control,26 the outcomes that we studied. In addition, combinations of inhaled glucocorticoids and LABA therapy have been reported to provide superior asthma control, as compared with an increased dose of an inhaled glucocorticoid, even when the dose was more than doubled 27…”

An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses

“…Treatments included: anti-leukotrienes [ 64 , 65 ]; beta-agonists (inhaled/non-inhaled) [ 61 - 63 , 66 - 75 ]; allergen immunotherapy [ 76 ]; anti-IgE [ 77 ]; antibiotics [ 78 ]; anti-cholinergics [ 57 ]; azathioprine [ 79 ]; beclomethasone [ 80 - 82 ]; budesonide [ 83 , 84 ]; caffeine [ 85 ]; beta-blockers [ 58 ]; chloroquine [ 86 ]; corticosteroids (inhaled/non-inhaled) [ 59 , 60 , 87 - 91 ]; cyclosporine [ 92 ]; fluticasone [ 93 - 96 ]; anti-gastro-oesophageal reflux treatment [ 97 ]; gold [ 98 ]; inhaled/non-inhaled magnesium sulphate [ 98 , 100 ]; macrolides [ 101 , 102 ]; methotrexate [ 103 ]; oxatomide [ 104 ]; and tailored interventions based on sputum eosinophils [ 105 ].…”

Dupilumab Among Patients with Uncontrolled Severe Asthma in China: A Cost-Utility Analysis

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Tiotropium Bromide Step-Up Therapy for Adults with Uncontrolled Asthma

“…Although an increase in the dose of an inhaled glucocorticoid by a factor of four has been reported to reduce asthma exacerbations,25 low doses of an inhaled glucocorticoid have been reported to provide a benefit equivalent to that of a high dose with respect to measures of asthma control,26 the outcomes that we studied. In addition, combinations of inhaled glucocorticoids and LABA therapy have been reported to provide superior asthma control, as compared with an increased dose of an inhaled glucocorticoid, even when the dose was more than doubled 27…”

An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses

“…Treatments included: anti-leukotrienes [ 64 , 65 ]; beta-agonists (inhaled/non-inhaled) [ 61 - 63 , 66 - 75 ]; allergen immunotherapy [ 76 ]; anti-IgE [ 77 ]; antibiotics [ 78 ]; anti-cholinergics [ 57 ]; azathioprine [ 79 ]; beclomethasone [ 80 - 82 ]; budesonide [ 83 , 84 ]; caffeine [ 85 ]; beta-blockers [ 58 ]; chloroquine [ 86 ]; corticosteroids (inhaled/non-inhaled) [ 59 , 60 , 87 - 91 ]; cyclosporine [ 92 ]; fluticasone [ 93 - 96 ]; anti-gastro-oesophageal reflux treatment [ 97 ]; gold [ 98 ]; inhaled/non-inhaled magnesium sulphate [ 98 , 100 ]; macrolides [ 101 , 102 ]; methotrexate [ 103 ]; oxatomide [ 104 ]; and tailored interventions based on sputum eosinophils [ 105 ].…”

Dupilumab Among Patients with Uncontrolled Severe Asthma in China: A Cost-Utility Analysis

“……”

Tiotropium Bromide Step-Up Therapy for Adults with Uncontrolled Asthma

“…Although an increase in the dose of an inhaled glucocorticoid by a factor of four has been reported to reduce asthma exacerbations,25 low doses of an inhaled glucocorticoid have been reported to provide a benefit equivalent to that of a high dose with respect to measures of asthma control,26 the outcomes that we studied. In addition, combinations of inhaled glucocorticoids and LABA therapy have been reported to provide superior asthma control, as compared with an increased dose of an inhaled glucocorticoid, even when the dose was more than doubled 27…”

An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses

“…Treatments included: anti-leukotrienes [ 64 , 65 ]; beta-agonists (inhaled/non-inhaled) [ 61 - 63 , 66 - 75 ]; allergen immunotherapy [ 76 ]; anti-IgE [ 77 ]; antibiotics [ 78 ]; anti-cholinergics [ 57 ]; azathioprine [ 79 ]; beclomethasone [ 80 - 82 ]; budesonide [ 83 , 84 ]; caffeine [ 85 ]; beta-blockers [ 58 ]; chloroquine [ 86 ]; corticosteroids (inhaled/non-inhaled) [ 59 , 60 , 87 - 91 ]; cyclosporine [ 92 ]; fluticasone [ 93 - 96 ]; anti-gastro-oesophageal reflux treatment [ 97 ]; gold [ 98 ]; inhaled/non-inhaled magnesium sulphate [ 98 , 100 ]; macrolides [ 101 , 102 ]; methotrexate [ 103 ]; oxatomide [ 104 ]; and tailored interventions based on sputum eosinophils [ 105 ].…”

Dupilumab Among Patients with Uncontrolled Severe Asthma in China: A Cost-Utility Analysis

“……”