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Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations

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McKeever, Tricia, Mortimer, Kevin ORCID: https://orcid.org/0000-0002-8118-8871, Wilson, Andrew, Walker, Samantha, Brightling, Christopher, Skeggs, Andrew, Pavord, Ian, Price, David, Duley, Lelia, Thomas, Mike, Bradshaw, Lucy, Higgins, Bernard, Haydock, Rebecca, Mitchell, Eleanor, Devereux, Graham and Harrison, Timothy (2018) 'Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations'. New England Journal of Medicine, Vol 378, pp. 901-910.

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Abstract

BACKGROUND:
Asthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a plan for patients to manage their asthma (self-management plan), which included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate, would reduce the incidence of severe asthma exacerbations among adults and adolescents with asthma.

METHODS:
We conducted a pragmatic, unblinded, randomized trial involving adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without add-on therapy, and who had had at least one exacerbation in the previous 12 months. We compared a self-management plan that included an increase in the dose of inhaled glucocorticoids by a factor of 4 (quadrupling group) with the same plan without such an increase (non-quadrupling group), over a period of 12 months. The primary outcome was the time to a first severe asthma exacerbation, defined as treatment with systemic glucocorticoids or an unscheduled health care consultation for asthma.

RESULTS:
A total of 1922 participants underwent randomization, of whom 1871 were included in the primary analysis. The number of participants who had a severe asthma exacerbation in the year after randomization was 420 (45%) in the quadrupling group as compared with 484 (52%) in the non-quadrupling group, with an adjusted hazard ratio for the time to a first severe exacerbation of 0.81 (95% confidence interval, 0.71 to 0.92; P=0.002). The rate of adverse effects, which were related primarily to local effects of inhaled glucocorticoids, was higher in the quadrupling group than in the non-quadrupling group.

CONCLUSIONS:
In this trial involving adults and adolescents with asthma, a personalized self-management plan that included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate resulted in fewer severe asthma exacerbations than a plan in which the dose was not increased. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN15441965 .).

Item Type: Article
Subjects: QV Pharmacology > QV 4 General works
WF Respiratory System > Lungs > WF 600 Lungs
WK Endocrine System > WK 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1056/nejmoa1714257
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 09 Mar 2018 14:32
Last Modified: 06 Dec 2018 11:23
URI: https://archive.lstmed.ac.uk/id/eprint/8330

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