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Review: adults who require inhaled corticosteroids benefit from a moderate starting dose

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 Q In patients with asthma not treated by inhaled corticosteroids (ICSs), what is the optimum starting dose?

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Embedded ImageData sources:

Cochrane Airways Group register (includes studies from Medline, EMBASE/Excerpta Medica, CINAHL, hand searched respiratory journals, and meeting abstracts).

Embedded ImageStudy selection and assessment:

randomised controlled trials (RCTs) comparing 2 different doses (including step down therapy) of the same ICS for ⩾4 weeks in patients with oral steroid independent asthma.

Embedded ImageOutcomes:

asthma symptoms, lung function, exacerbations, airway hyperresponsiveness (AHR), and asthma control.


Of 26 RCTs (4–24 mo duration) that met the selection criteria, 17 were in adults. Step down v constant ICS. No significant differences were reported for FEV1, symptoms, use of rescue medication in adults, adverse events, or asthma control. High v moderate ICS dose. 2 RCTs showed an improvement for …

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  • For correspondence: Dr P Gibson, John Hunter Hospital, Newcastle, New South Wales, Australia

  • Sources of funding: Cooperative Research Centre for Asthma.