Concern over asthma dose doubling

Taking inhaled steroids can reduce the risk of attacks

Advice to asthmatics to boost their intake of drugs when their condition deteriorates may be flawed, say Nottingham researchers.

Many people with the illness are told to take more steroid inhaler doses to get the disease back under control.

However, the researchers, writing in the Lancet medical journal, say that there is "little evidence" this has any impact on asthma.

One in eight in the UK have suffered the wheezing illness at some point.

The key to asthma therapy is getting the symptoms under control, so that patients suffer fewer "attacks" and need less of their "reliever" inhalers.

This is achieved using another drug, a steroid, which cannot help someone having an attack, but if taken regularly can reduce the chance of flare-ups.

Self-administered

One system of self-management involves patients frequently measuring their lung capacity by blowing into a peak flow meter.

Our findings provide little support for the recommendation that patients taking an inhaled corticosteroid should double the dose when asthma control is deteriorating Researchers, Nottingham City Hospital

When the reading starts to go down - a sign that the disease is less well controlled - the patients are advised to double the amount of the steroid inhaler they take,

The idea behind this is to reduce the amount of time it takes to reintroduce control.

The team from City Hospital Nottingham launched a study to test whether the extra steroids were having an impact.

They gave patients an extra supply of inhalers, and told them to break into it when their peak flows began to worsen.

Some patients, however, received dummy inhalers with no drug in them.

The two groups were then compared to see if the extra steroids were good for the patient.

No impact

They found that doubling the dose of inhaled steroids had no impact on the length of time it took for peak flow to return to normal levels.

It had no effect on the number of patients who ended up needing more powerful steroids in pill form to control their asthma.

"Our findings provide little support for the recommendation that patients taking an inhaled corticosteroid should double the dose when asthma control is deteriorating." they wrote.

Professor Martyn Partridge, Chief Medical Advisor to the National Asthma Campaign, welcomed the study.

He said: "It gives us more information about how to manage deteriorating asthma.

"However, it does not in any way detract from the British Asthma Guideline recommendation that people with asthma should be given personalised advice as to how to alter their therapy themselves to keep themselves well.

"Such advice should include, as the authors of this paper say, a reserve supply of steroid tablets."