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Short-term rise in steroid dose ‘does not’ prevent asthma flare-ups

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Temporarily increasing the dosage of inhaled steroids when asthma symptoms begin to worsen does not effectively prevent severe flare-ups, according to US researchers.

In addition, doing so may be associated with slowing a child’s growth, warned the researchers. They highlighted that their findings challenged a common practice involving children with mild-to-moderate asthma.

“A short-term increase to high-dose inhaled steroids should not be routinely included in asthma treatment plans”

Daniel Jackson

They noted that many health professionals recommend increasing the doses of inhaled steroids from low to high at early signs of symptoms, such as coughing, wheezing, and shortness of breath.

Until now, they said researchers had not rigorously tested the safety and efficacy of this strategy in children with mild-to-moderate asthma.

The team behind the new study looked at 254 children, aged five to 11 years, with mild-to-moderate asthma for nearly a year. All were treated with low-dose inhaled corticosteroids – two puffs twice a day.

At the earliest signs of an asthma exacerbation, the researchers continued giving low-dose inhaled steroids to half of the children and increased to high-dose inhaled steroids – five times the standard dose – in the other half, twice daily for seven days during each episode.

Though the children in the high-dose group had 14% more exposure to inhaled steroids than the low-dose group, they did not experience fewer severe exacerbations.

The number of asthma symptoms, the length of time until the first severe flare-up, and the use of the rescue medication albuterol were similar between the two groups.

Unexpectedly, the rate of growth of children in the short-term high-dose strategy group was about 0.23cm per year less than the rate for children in the low-dose strategy group.

While the growth difference was small, the finding echoes previous studies showing children who take inhaled corticosteroids for asthma may experience a small negative impact on growth rate.

“Trials like this can be used in the development of treatment guidelines for children with asthma”

James Kiley

More frequent or prolonged high-dose steroid use in children might increase this adverse effect, the researchers cautioned.

Lead study author Dr Daniel Jackson, from the University of Wisconsin School of Medicine and Public Health, said: “These findings suggest that a short-term increase to high-dose inhaled steroids should not be routinely included in asthma treatment plans for children with mild-moderate asthma who are regularly using low-dose inhaled corticosteroids.”

But he added: “Low-dose inhaled steroids remain the cornerstone of daily treatment in affected children.”

Dr James Kiley, director of the lung diseases division at the US National Heart, Lung, and Blood Institute, which funded the study, said: “Trials like this can be used in the development of treatment guidelines for children with asthma.”

The study is being published in the New England Journal of Medicine and presented at a joint conference hosted by the American Academy of Allergy, Asthma and Immunology and the World Allergy Organization in Florida.

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