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Doubling the dose of inhaled corticosteroids during asthma deterioration did not improve asthma control

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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 ★★★★★★☆


Embedded ImageDesign:

randomised, placebo controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:

blinded (clinicians and patients).*

Embedded ImageFollow-up period:

12 months.

Embedded ImageSetting:

a hospital in Nottingham, UK.

Embedded ImagePatients:

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.

Embedded ImageIntervention:

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, …

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  • * See glossary.

  • For correspondence: Dr T W Harrison, Nottingham City Hospital, Nottingham, UK.

  • Sources of funding: NHS Executive. Active and placebo corticosteroid inhalers provided by AstraZeneca, GlaxoWellcome, 3M, and Baker Norton.