1 June 2006

Increasing the dose of inhaled corticosteroids for asthma may not cause a proportionate improvement in the patient’s symptoms and lung function. It may be associated with a steeper rise in the risk of adverse events according to Professor Christine Jenkins, Head of the Asthma Group, Woolcock Institute of Medical Research, writing in the latest issue of Australian Prescriber.

All of the randomised placebo-controlled trials provide strong evidence that patients with mild persistent asthma achieve and maintain control of their asthma more effectively with inhaled corticosteroids, and all guidelines agree that the starting dose of inhaled corticosteroids should be appropriate to the severity of the disease. However the continued choice of dose is a vital element in asthma management.

Clinical trials and meta-analysis shows that the dose-response curve for inhaled corticosteroids is relatively flat.

"It is important to note that for the majority of patients there is little benefits increasing the dose. The aim of asthma management should be to reduce the dose of any inhaled corticosteroid when the patient’s asthma is stable.

"After the patient’s asthma has been well controlled and stable for six to eight weeks the dose of inhaled corticosteroid should be gradually decreased to the lowest clinically effective dose that maintains good control", said Professor Jenkins.

All guidelines emphasise the importance of ensuring good device use and checking compliance, inhaler technique and reviewing trigger factors before considering further increases in inhaled corticosteroid dose if patients have not achieved good asthma control.

It is important to note that inhaled corticosteroids may slow the rate of growth in children, but they do not appear to have significant effects on the child’s final height.

For further information, general practitioners, community pharmacists and other health professionals can contact the National Prescribing Service (NPS) Therapeutic Advice and Information Service (TAIS) on 1300 138 677 between 9am and 7pm EST. For the complete article visit the Australian Prescriber website www.australianprescriber.com.

ENDS

Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals. It is published by National Prescribing Service Limited (NPS), an independent, non-profit organisation funded by the Australian Government Department of Health and Ageing.