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'Dose Doubling Strategy' of Inhaled Steroids in Acute Ashtma Attack Being Questioned by New Studies

by Dr. Nithin Jayan on  October 20, 2010 at 7:46 PM Health Watch   - G J E 4
Increasing the dose of inhaled corticosteroids at the onset of an acute asthma aggravation may not cut down the need for rescue oral corticosteroids. Doubling the dose may provide false reassurance. The best practice is to prevent an exacerbation by ensuring regular use of inhaled corticosteroids.

Asthma is one of the most common reasons calling for medical treatment. The worldwide prevalence of asthma has increased more than 45% since the late 1970s. Unfortunately the exact cause of this clinical syndrome is still unknown.

During an acute attack of asthma people's airways constrict, this is termed bronchoconstriction. At this moment the effective treatment is to try and re-open the airways by inhaling bronchodilator drugs. Asthma also involves an underlying inflammation in the lungs. The magnitude of inflammation varies. Factors like respiratory virus infections, allergens and other irritants make the inflammation worse. Thus they bring in a greater obstruction of the airways. Theoretically higher doses of inhaled corticosteroids could treat such increased inflammation. If a patient doesn't sufficiently respond to this they may need to use rescue oral corticosteroids.

Presently many doctors suggest that patients may double the usual dose of inhaled corticosteroids at the first sign of an asthma attack to minimise or abort the flare-up of asthma. This strategy is very common.

Recent randomized controlled trials have shown that this strategy is not effective. In fact doubling the dose may provide only false reassurance. Increasing the dose of inhaled corticosteroids at the onset of an acute asthma aggravation may not cut down the need for rescue oral corticosteroids. The safety of the 'doubling strategy' is now being questioned. The results of the studies were published in the The Cochrane Library this month.

Authoritative studies are required. So, as of now it seems that the best practice is to prevent an exacerbation by ensuring regular use of inhaled corticosteroids.

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