Inhaled corticosteroids (ICS) dose–response relationship

Start with a low-dose inhaled corticosteroid (ICS) in adults and children to avoid adverse effects.1 The main effect of increasing dose is an increase in side-effects with little additional benefit to most patients;2 there is also no clear benefit for starting at high doses.3 Figure 1 illustrates a stylised dose–response curve for ICS dosing. While the dose–response for benefits from clinical efficacy of ICS is flat, the dose–response for risk of adverse effects is steep.2-4 Studies show that 90% of the benefit from ICS occurs in the 100–250 microgram dose range.4

Some patients need higher doses of ICS

In patients who need higher doses of ICS in order to achieve and maintain good asthma control, weigh the benefits against risks for adverse effects. In children, higher doses are associated with systemic effects including adrenal suppression, growth suppression and effects on bone mineralisation.5

 Stylised dose–response curve for inhaled corticosteroids showing that 90% of the benefit is gained from doses in the 100–250 microgram range

Figure 1: Stylised dose–response curve for inhaled corticosteroiods.2,4

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  1. Australian asthma handbook. Melbourne: National Asthma Council Australia, 2014. [Online] (accessed 4 March 2014).
  2. Powell H, Gibson PG. Med J Aust 2003;178:223–5. [Pubmed]
  3. Powell H, Gibson PG. Cochrane Database Syst Rev 2004:CD004109. [Pubmed]
  4. Holt S, et al. BMJ 2001;323:253–6. [Pubmed]
  5. van Asperen P, et al. The role of corticosteroids in the management of childhood asthma. 2010. [Fulltext] (accessed 4 March 2014).