Research on High Doses of Inhaled Steroids for Asthma Management
Introduction to Asthma and Its Prevalence
Asthma is a chronic disease that affects around 300 million individuals globally, making it one of the most prevalent conditions today. Asthma attacks can be distressing and potentially life-threatening. Many patients utilize inhaled glucocorticoids as part of their self-management strategies to improve asthma control. However, there is ongoing debate among experts regarding the optimal dosage of inhaled glucocorticoids necessary to effectively manage and prevent acute asthma attacks.
Previous Research Findings
Some guidelines propose that doubling the dosage of inhaled glucocorticoids can help in preventing asthma attacks. In contrast, other studies indicate that increasing the dosage does not significantly lower the chances of hospitalization, the need for oral glucocorticoids, or the duration of recovery. In light of these contrasting findings, researchers in the UK conducted a non-blinded randomized controlled trial to explore the effects of quadrupling the currently recommended dose of inhaled glucocorticoids. The results of their study were published in the New England Journal of Medicine.
Study Objectives and Methodology
The primary goal of the recent study was to determine whether a temporary four-fold increase in inhaled glucocorticoids could lead to a decrease in the reliance on oral glucocorticoids or reduce asthma-related emergency visits. The study involved 1,871 adults and adolescents with asthma who were already on inhaled glucocorticoids and had experienced at least one asthma attack in the preceding year. Participants were randomly assigned to one of two groups: one group followed a self-management plan that included a four-fold increase in inhaled glucocorticoids (the quadrupling group), while the other group adhered to the same plan without the increased dosage (the non-quadrupling group).
Results of the Quadrupling Dosage
The findings revealed that participants in the quadrupling group experienced fewer asthma attacks over the 12-month period compared to the non-quadrupling group (45% vs. 52%, respectively). Furthermore, the average duration until the first severe asthma attack was significantly extended for those in the quadrupling group. Additionally, this group reported fewer asthma-related hospitalizations (3 compared to 18 in the non-quadrupling group). However, a notable side effect observed among patients in the quadrupling group was the development of thrush, an oral yeast infection.
Conclusion and Implications
While the outcomes were not as definitive as the researchers had anticipated, they believe the study provides support for the temporary quadrupling of inhaled glucocorticoid doses to prevent asthma attacks. Several factors must be considered, including the study’s non-blinded design, which may introduce bias. Although no serious side effects were reported in the quadrupling group compared to the standard dosage group, further research is essential to ascertain the long-term safety of administering such high doses.
Reference
McKeever T, Mortimer K, Wilson A et al. Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations. N Engl J Med 2018; 378:902-10.