Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children

Abstract

There is very little evidence from trials in children. In adults with asthma on daily maintenance ICS, a self-initiated ICS increase to 1000 to 2000 mcg/day at the onset of an exacerbation is not associated with a statistically significant reduction in the risk of exacerbations requiring rescue oral corticosteroids. More research is needed to assess the effectiveness of increased ICS doses at the onset of asthma exacerbations (particularly in children).

Should we Substitute Intermittent for Maintenance Inhaled Corticosteroids in Patients with Persistent Asthma? A Systematic Review and Meta-Analysis

“…Whether administered as 4-fold increase from the baseline maintenance ICS dose or whenever a dose of ICS was added whenever a dose of rescue β 2 -agonists was needed, the ICS dose during exacerbations did not appear to influence the magnitude of effect. This observation supports the conclusion derived from a recent Cochrane review where a two-to four-fold ICS step-up (1000 to 2000 μg/day) at the onset of an exacerbation was not associated with a statistically significant reduction in the risk of exacerbation requiring oral corticosteroids in adults on maintenance ICS [25].…”

Should we Substitute Intermittent for Maintenance Inhaled Corticosteroids in Patients with Persistent Asthma? A Systematic Review and Meta-Analysis

“…Whether administered as 4-fold increase from the baseline maintenance ICS dose or whenever a dose of ICS was added whenever a dose of rescue β 2 -agonists was needed, the ICS dose during exacerbations did not appear to influence the magnitude of effect. This observation supports the conclusion derived from a recent Cochrane review where a two-to four-fold ICS step-up (1000 to 2000 μg/day) at the onset of an exacerbation was not associated with a statistically significant reduction in the risk of exacerbation requiring oral corticosteroids in adults on maintenance ICS [25].…”

Effect of different asthma treatments on risk of cold-related exacerbations

“…Adding LABA reduces all-cause exacerbations compared with ICS alone, although the advantage of adding LABA is smaller when the comparator is double-dose ICS [5]. By contrast with the present findings, increasing ICS dose after several days of worsening asthma is ineffective, except perhaps with a quadrupled dose [16].…”

Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics

“…Two Cochrane reviews [ 45 , 46 ], including both adult and pediatric studies, conclude that there is insufficient evidence that ICS treatment results in clinically important changes in pulmonary function or clinical scores when used in acute asthma in addition to SS [ 45 , 46 ]. Therefore there is insufficient evidence that ICS therapy can be used in place of SS therapy when treating acute asthma [ 45 , 46 ]. A 2012 Cochrane Review [ 47 ] evaluated the effectiveness of the ICS treatment after discharge from ED and concluded that ICS provides no additional benefit to standard therapy with SS in the post-discharge treatment of children with acute asthma.…”

Should we Substitute Intermittent for Maintenance Inhaled Corticosteroids in Patients with Persistent Asthma? A Systematic Review and Meta-Analysis

“…Whether administered as 4-fold increase from the baseline maintenance ICS dose or whenever a dose of ICS was added whenever a dose of rescue β 2 -agonists was needed, the ICS dose during exacerbations did not appear to influence the magnitude of effect. This observation supports the conclusion derived from a recent Cochrane review where a two-to four-fold ICS step-up (1000 to 2000 μg/day) at the onset of an exacerbation was not associated with a statistically significant reduction in the risk of exacerbation requiring oral corticosteroids in adults on maintenance ICS [25].…”

Effect of different asthma treatments on risk of cold-related exacerbations

“…Adding LABA reduces all-cause exacerbations compared with ICS alone, although the advantage of adding LABA is smaller when the comparator is double-dose ICS [5]. By contrast with the present findings, increasing ICS dose after several days of worsening asthma is ineffective, except perhaps with a quadrupled dose [16].…”

Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics

“…Two Cochrane reviews [ 45 , 46 ], including both adult and pediatric studies, conclude that there is insufficient evidence that ICS treatment results in clinically important changes in pulmonary function or clinical scores when used in acute asthma in addition to SS [ 45 , 46 ]. Therefore there is insufficient evidence that ICS therapy can be used in place of SS therapy when treating acute asthma [ 45 , 46 ]. A 2012 Cochrane Review [ 47 ] evaluated the effectiveness of the ICS treatment after discharge from ED and concluded that ICS provides no additional benefit to standard therapy with SS in the post-discharge treatment of children with acute asthma.…”

Should we Substitute Intermittent for Maintenance Inhaled Corticosteroids in Patients with Persistent Asthma? A Systematic Review and Meta-Analysis

“…Whether administered as 4-fold increase from the baseline maintenance ICS dose or whenever a dose of ICS was added whenever a dose of rescue β 2 -agonists was needed, the ICS dose during exacerbations did not appear to influence the magnitude of effect. This observation supports the conclusion derived from a recent Cochrane review where a two-to four-fold ICS step-up (1000 to 2000 μg/day) at the onset of an exacerbation was not associated with a statistically significant reduction in the risk of exacerbation requiring oral corticosteroids in adults on maintenance ICS [25].…”

Effect of different asthma treatments on risk of cold-related exacerbations

“…Adding LABA reduces all-cause exacerbations compared with ICS alone, although the advantage of adding LABA is smaller when the comparator is double-dose ICS [5]. By contrast with the present findings, increasing ICS dose after several days of worsening asthma is ineffective, except perhaps with a quadrupled dose [16].…”

Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics

“…Two Cochrane reviews [ 45 , 46 ], including both adult and pediatric studies, conclude that there is insufficient evidence that ICS treatment results in clinically important changes in pulmonary function or clinical scores when used in acute asthma in addition to SS [ 45 , 46 ]. Therefore there is insufficient evidence that ICS therapy can be used in place of SS therapy when treating acute asthma [ 45 , 46 ]. A 2012 Cochrane Review [ 47 ] evaluated the effectiveness of the ICS treatment after discharge from ED and concluded that ICS provides no additional benefit to standard therapy with SS in the post-discharge treatment of children with acute asthma.…”