Quintupling Glucocorticoid Dose: Is it Safe, Effective in Pediatric Asthma?

Researchers analyzed 254 children with mild-to-moderate persistent asthma treated with systemic glucocorticoids
Researchers analyzed 254 children with mild-to-moderate persistent asthma treated with systemic glucocorticoids

HealthDay News — Quintupling the dose of inhaled glucocorticoids seems not to be effective for preventing exacerbations among children with asthma, while quadrupling the dose may be beneficial for adolescents and adults, according to two studies published online March 3 in the New England Journal of Medicine.

Daniel J. Jackson, MD, from the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues studied 254 children aged 5 to 11 years with mild-to-moderate persistent asthma treated with systemic glucocorticoids. Children were treated with maintenance low-dose inhaled glucocorticoids for 48 weeks and were then randomized to continue to the same dose or a quintupled dose. The researchers found that there was no significant difference between the groups in the rate of severe asthma exacerbations treated with systemic glucocorticoids (0.48 versus 0.37 exacerbations per year in the high- versus low-dose groups; 95% confidence interval, 0.8 to 2.1; P=0.3). 

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Tricia McKeever, Ph.D., from the University of Nottingham in the United Kingdom, and colleagues compared a self-management plan that included a temporary quadrupling in the dose of inhaled glucocorticoids with the same plan without such an increase over 12 months among 1,871 adults and adolescents with asthma with at least 1  exacerbation in the previous 12 months. The researchers found that 45 and 52% in the quadrupling and non-quadrupling groups had a severe asthma exacerbation in the year after randomization (adjusted hazard ratio for time to a first severe exacerbation, 0.81; 95% confidence interval, 0.71 to 0.92; P=0.002).

"A small subgroup of adults and adolescents with asthma may have a response to an escalation strategy; however, their baseline and exacerbation characteristics remain to be defined," writes the author of an accompanying editorial.

Several authors in both studies disclosed financial ties to pharmaceutical companies.

Abstract/Full Text - Jackson
Abstract/Full Text - McKeever
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