April 13, 2018

Asthma study: High-dose inhaled corticosteroids

A study recently published by researchers at the University of Wisconsin School of Medicine and Public Health found that short-term increases to high-dose of inhaled corticosteroids (ICS) does not effectively prevent asthma flare-ups in children, but does that mean it's time to rip up your child's asthma treatment plan?

"Parents definitely should not change their child's asthma plan without first talking to their doctor," said Daniel Jackson, MD, associate professor of pediatrics at UW.

Jackson, an expert on childhood asthma who led the study, said parents, physicians and asthma treatment guideline committees should take note of the findings because avoiding this ineffective strategy could save families money and mitigate potential side effects — particularly a decline in growth rate seen in children who took high doses of corticosteroids during the study.

"The growth effect that we saw in the study was quite small, but what concerned us is that if the strategy was used more frequently, there would be potential for greater effect," Jackson said.

Know your corticosteroids and how they're used in your child's treatment

Jackson's study examined temporary increases to high-dose ICS among children who already regularly take low doses. ICS, not to be confused with "rescue" medications like albuterol inhalers, are considered "controller" and are taken daily for prevention of asthma symptoms.

Commonly prescribed inhaled corticosteroids include:

  • beclomethasone (Qvar)

  • budesonide (Pulmicort Flexhaler)

  • ciclesonide (Alvesco)

  • fluticasone (Flovent Diskus, Flovent HFA, Arnuity Ellipta)

  • mometasone (Asmanex)

During the study, the research team studied 254 children 5 to 11 years of age for nearly a year. All the children were treated with low-dose inhaled corticosteroids regularly (two puffs from an inhaler twice daily) for mild to moderate asthma. At the early signs of asthma flare-up, which some children had several times throughout the year, the researchers continued giving low-dose ICS to half of the children and increased to high-dose ICS (five times the standard dose) in the other half. The higher dosages were given twice daily for seven days during each episode.

Though the children in the high-dose group had 14 percent more exposure to inhaled steroids than the low-dose group, they did not have fewer severe flare-ups. The number of asthma symptoms, the length of time until the first severe flare-up, and the use of albuterol (a drug used as a rescue medication for asthma symptoms) were similar between the two groups.

Jackson says there's one caveat to the study:

"This really focuses on increasing the dose in patients who are already taking an ICS regularly. For people with intermittent asthma, starting a high dose at the early onset of symptoms can be effective," he said.

"Ultimately, it's important for children who have persistent asthma to use a preventative inhaler, but temporarily increasing the dose of that medicine when asthma symptoms start to flare is not an effective strategy."