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Q In patients with asthma, does doubling the dose of inhaled corticosteroid (ICS) reduce the need for prednisolone when control starts to deteriorate?
Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★☆ Allergy ★★★★★★☆ Respirology ★★★★★★☆
METHODS
Design:
randomised, placebo controlled trial.
Allocation:
concealed.*
Blinding:
blinded (clinicians and patients).*
Follow-up period:
12 months.
Setting:
a hospital in Nottingham, UK.
Patients:
390 patients who were ⩾16 years of age (mean age 49 y, 67% women) with a clinical diagnosis of asthma; were taking ICS, 100–2000 μg/d on a regular basis; and required oral corticosteroids or doubled their dose of ICS in the previous 12 months. Exclusion criteria: history of smoking >10 pack years or unstable asthma during a 2 week run in period.
Intervention:
patients were stratified by entry ICS dose (low to moderate or high) and allocated to an active inhaler (n = 192) or a placebo inhaler (n = 198). Study inhalers were matched to patients’ regular ICS, …