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Severe asthma attacks reduced by quadrupling steroids, finds study

Quadrupling the dose of inhaled steroids temporarily when asthma control begins to deteriorate could reduce the risk of a severe asthma attack.

A trial including nearly 2,000 adults and adolescents who were receiving inhaled corticosteroids were 19% less likely to suffer a severe exacerbation.

The University of Nottingham team compared two self-management plans, one which included quadrupling the dose of inhaled steroids and one which did not, over 12 months.

Their paper, published in New England Journal of Medicine, said that ‘temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate resulted in fewer severe asthma exacerbations than a plan in which the dose was not increased’.

But they admitted that ‘the magnitude of reduction was smaller than expected’, having set out to see whether incidence of severe exacerbations could be reduced by 30%.

The researchers noted that there was a higher frequency of treatment-related adverse effects in the quadrupling group, such as oral candidiasis, but no significant difference in the incidence of pneumonia was seen between the two groups.

Asthma UK director of research and policy Dr Samantha Walker, who co-authored the paper, said the ‘groundbreaking’ research could 'make a real difference' to patients.

She said: 'This study showed that increasing the steroids in someone’s preventer inhaler could prevent them having severe asthma attacks and needing to go to hospital.

‘We’d urge any healthcare professionals who want to increase their patient’s asthma medication to fully explain what it means, let them know about potential side effects and include it in their written asthma action plan.'

This finding follows previous research from the university, which found that doubling the dose of inhaled steroids during worsening asthma did not prevent the frequency of serious attacks.

New Eng J Med 2018, online 8 Mar