Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Oct;49(10):1283-1290.
doi: 10.1111/cea.13450. Epub 2019 Jul 15.

Increased versus stable dose of inhaled corticosteroids for asthma exacerbations: A systematic review and meta-analysis

Yu Zhang  1 , Jialing He  1 , Yulai Yuan  2 , Andrew Faramand  3 , Fang Fang  1 , Hongming Ji  4
Affiliations
Meta-Analysis

Increased versus stable dose of inhaled corticosteroids for asthma exacerbations: A systematic review and meta-analysis

Yu Zhang et al. Clin Exp Allergy. 2019 Oct.

Abstract

Background: Increasing the dose of inhaled corticosteroids (ICS) is commonly used at early signs of loss of asthma control. However, the potential benefits and harms of this strategy remain unclear. We performed a systematic review and meta-analysis to compare increased dose with stable dose of ICS among adults and children with asthma.

Methods: We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from inception to August 02, 2018. Randomized clinical trials comparing increased doses vs stable doses of ICS for home management of asthma exacerbations in adults or children were included.

Results: The analyses included 8 trials totalling 3866 patients. Four trials were judged as low risk of bias, three were unclear risk, and one was ranked as high risk. Increased dose of ICS was associated with a significantly reduced risk of treatment failure compared with stable dose (OR 0.82, 95% CI 0.70-0.97, I2 = 6%; 314 (281 to 351) vs 358 events per 1000 patients; moderate-quality evidence). There was no significant difference in unscheduled physician visits or hospital admission between increased or stable dose of ICS. However, increased dose of ICS increased the risk of non-serious adverse events (OR 3.50, 95% CI 1.93-6.35, I2 = 0%) but not serious adverse events.

Conclusions: Current evidence of moderate quality supports increasing the dose of ICS as part of a self-initiated action plan to reduce risk of requiring a course of systemic corticosteroids in people with an asthma exacerbation. However, we did not find evidence for an impact on hospital admissions or unscheduled physician visits, and increased ICS dose increased risk of non-serious adverse events.

Keywords: asthma; clinical immunology; pharmacology and pharmacogenomics.

PubMed Disclaimer

References

REFERENCES

    1. Global_Asthma_Network. Global Asthma. Report 2014. 2014. http://www.globalasthmareport.org/resources/Global_Asthma_Report_2014.pdf. Accessed June 1, 2018.
    1. Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. 2017;3:1.
    1. Ortega H, Yancey SW, Keene ON, Gunsoy NB, Albers FC, Howarth PH. Asthma exacerbations associated with lung function decline in patients with severe eosinophilic asthma. J Allergy Clin Immunol Pract. 2018;6(3):980-986 e981.
    1. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW, Group SI. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179(1):19-24.
    1. British Thoracic S. Scottish Intercollegiate Guidelines N. British guideline on the management of asthma. Thorax. 2014;69(Suppl 1):1-192.

Substances