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Increasing inhaled steroid dose in asthma exacerbations

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Ever since inhaled corticosteroids (ICS) were first introduced as an effective prophylactic agent, there has been a debate over whether asthma exacerbations can be treated by increasing the dose. In theory, as we know systemic steroids are highly effective, they should work. A popular strategy is doubling the dose at the first sign of an exacerbation (sometimes termed the ‘yellow zone’), but trials have not shown this to be effective. Could increasing the dose by a factor of four or five work better?

The NEJM recently published two trials side-by-side addressing this question, which came to opposing conclusions. The first, from multiple …

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