Could Quintupling Dose of Asthma Meds Reduce Exacerbations in Children?

Quintupling the dose of inhaled glucocorticoids at the early signs of a severe asthma exacerbation does not effectively lower the rate of exacerbations among children with mild-to-moderate asthma, according to a new study.¹

Findings from the study were presented at the American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress 2018, which is taking place from March 2 to 5, 2018, in Orlando, Florida.
_____________________________________________________________________________

RELATED CONTENT
Asthma, Allergy Risks Heightened With Early-Life Antibiotic Use
Does Once-Daily Asthma Treatment Improve Adherence?
_____________________________________________________________________________

Researchers evaluated 254 children aged 5 to 11 years with mild-to-moderate persistent asthma who had had at least 1 exacerbation treated with systemic glucocorticoids in the previous year. Children were treated with 2 twice-daily inhalations of maintenance low-dose inhaled glucocorticoids (44 μg fluticasone propionate per inhalation) for 48 weeks.

Subsequently, they were randomly assigned to continue the same dose (low-dose group) or receive a quintupled dose of 220 μg fluticasone per inhalation (2 inhalations twice daily; high-dose group) for 7 days if they approached the “yellow zone,” or demonstrated early signs of loss of asthma control.

Results revealed that the rate of severe exacerbations did not vary significantly between groups, with a rate of 0.48 exacerbations per year in the high-dose group vs 0.37 per year in the low-dose group. Furthermore, the researchers did not observe any significant between-group differences in the time to the first exacerbation, the rate of treatment failure, symptom scores, and albuterol use during “yellow-zone” episodes.

“In children with mild-to-moderate persistent asthma treated with daily inhaled glucocorticoids, quintupling the dose at the early signs of loss of asthma control did not reduce the rate of severe asthma exacerbations or improve other asthma outcomes and may be associated with diminished linear growth,” the researchers concluded.

However, in a similar study of adults and adolescents with asthma (N = 1922), researchers found that the temporary quadrupling of the dose of inhaled glucocorticoids at the early signs of the loss of asthma control may be associated with fewer exacerbations.²

—Christina Vogt

Reference:

1. Jackson DJ, Bacharier LB, Mauger DT, et al; National Heart, Lung, and Blood Institute AsthmaNet. Quintupling inhaled glucocorticoids to prevent childhood asthma exacerbations [Published online March 3, 2018]. N Eng J Med. doi:10.1056/NEJMoa1710988.

2. McKeever T, Mortimer K, Wilson A, et al. Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations [Published online March 3, 2018]. N Eng J Med. doi:10.1056/NEJMoa1714257.