Treatment of acute asthmatic exacerbations with an increased dose of inhaled steroid
a Department of
Paediatrics and Child Health, Dunedin School of Medicine, PO Box 913, University of Otago Medical School, Dunedin, New Zealand, b Department of Preventive and Social
Medicine, Dunedin School of Medicine, c Department of Respiratory Medicine, Dunedin
School of Medicine, d Department
of Paediatrics and Child Health, Dunedin School of Medicine
Correspondence to: Professor Holdaway.
Accepted 27
January 1998
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.
DESIGNRandomised,
double blind, placebo controlled, crossover trial.
METHODSTwenty 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.
RESULTSThere 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.
CONCLUSIONThis 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.
© 1998 by Archives of Disease in Childhood
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