Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations
Open accessAbstract
BACKGROUND: Previous guidelines recommend doubling the daily dose of maintenance inhaled corticosteroid to treat or prevent progression of exacerbations of asthma. METHODS: Over a 6 month period a cohort of patients were evaluated prospectively and randomised in a double blind controlled trial to treatment with either a continued maintenance dose (MD) of inhaled corticosteroid or doubling the dose (DD) at the time of an exacerbation. RESULTS: A total of 290 patients were randomised (33% male) and 98 (DD, n = 46) experienced evaluable asthma exacerbations during the study period. Mean (SD) baseline characteristics at randomisation (age 33.5 (14.0) years; forced expiratory volume in 1 second (FEV(1)) 2.8 (0.7) l; peak expiratory flow (PEF) 422.9 (110.5) l/min) were similar in both groups. In the DD group 41% of patients were considered treatment failures because they either required systemic steroids (n = 12), had an unscheduled visit to a physician (n = 1), or their asthma did not return to baseline (n = 6). This did not differ from the MD group in which 40% were treatment failures (n = 9, 0, and 12, respectively; p = 0.94). CONCLUSIONS: In patients who regularly take an inhaled corticosteroid, doubling the maintenance dose may not affect the pattern of the exacerbation.
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In vivo, NO deficiency is implicated in the development of airway hyperresponsiveness after viral respiratory infection in guinea pigs.
“In vivo, NO deficiency is implicated in the development of airway hyperresponsiveness after viral respiratory infection in guinea pigs (67).”
From The airway epithelium: soldier in the fight against respiratory viruses (2011) · cites this paper as [67]
Epithelial damage is associated with perturbations in airway homeostasis, such as decreased production of smooth muscle relaxing factors (e.g., nitric oxide) leading to airway hyperresponsiveness.
“but also is associated with perturbations in airway homeostasis, such as decreased production of smooth muscle relaxing factors (e.g., nitric oxide) leading to airway hyperresponsiveness (67).”
From The airway epithelium: soldier in the fight against respiratory viruses (2011) · cites this paper as [67]
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Global Initiative for Asthma Strategy 2021
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Self-citationApproaches to stepping up and stepping down care in asthmatic patients
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Asthma diagnosis and treatment: Filling in the information gaps
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“effective.(51,52) In contrast, quadrupled doses of ICSs might be of benefit.”
BackgroundRice-McDonald, G. G., Bowler, S., Staines, G., & Mitchell, C. (2005) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2005.00972.x · Cited by 45 · see citing works
Prise en charge de la crise d’asthme de l’enfant (nourrisson inclus)
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McCann, K. L., & Imani, F. (2007) · Journal of Virology · doi:10.1128/jvi.02583-06 · Cited by 44 · see citing works
Assessment of asthma control and its impact on optimal treatment strategy
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“Two studies have demonstrated the apparent lack of effect on either the outcome or severity of asthma exacerbations of doubling the dose of inhaled corticosteroid treatment at the start of an exacerbation (67, 68).”
BackgroundEffect of different asthma treatments on risk of cold-related exacerbations
Reddel, H. K., Jenkins, C. R., Quirce, S., Sears, M. R., Bateman, E. D., O’Byrne, P. M., Humbert, M. J. C., Buhl, R., Harrison, T. W., Brusselle, G., et al. (2011) · European Respiratory Journal · doi:10.1183/09031936.00186510 · Cited by 38 · see citing works
“Given the rapid and intense inflammatory response to viral infection, further research is also needed to investigate potential action plan strategies for patients taking conventional fixeddose maintenance ICS/LABA with as-needed SABA, for example to evaluate the effectiveness of an immediate increase in ICS dose or sh…”
BackgroundMechanisms of respiratory virus‐induced asthma exacerbations
Contoli, M., Caramori, G., Mallia, P., Johnston, S. L., & Papi, A. A. (2005) · Clinical & Experimental Allergy · doi:10.1111/j.1365-2222.2005.02163.x · Cited by 36 · see citing works
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Management of acute loss of asthma control in the yellow zone: a practice parameter
Dinakar, C., Oppenheimer, J. J., Portnoy, J. M., Bacharier, L. B., Li, J. L., Kercsmar, C. M., Bernstein, D., Blessing-Moore, J., Khan, D. A., Lang, D. M., et al. (2014) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2014.05.017 · Cited by 35 · see citing works
Peak flow monitoring in clinical practice and clinical asthma trials
Reddel, H. K. (2005) · Current Opinion in Pulmonary Medicine · doi:10.1097/01.mcp.0000198065.65704.08 · Cited by 35 · see citing works
Acute asthma intervention: Insights from the STAY study
O’Byrne, P. M. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.03.007 · Cited by 33 · see citing works
Buhl, R., & Vogelmeier, C. F. (2007) · Current Medical Research and Opinion · doi:10.1185/030079907x210769 · Cited by 31 · see citing works
“Characteristic Salmeterol/ fluticasone Budesonide/ formoterol Budesonide/formoterol maintenance and reliever Salmeterol/ fluticasone Budesonide/formoterol maintenance and reliever (n = 912) (n = 892) (n = 908) (n = 1037) (n = 1030) Male, n (%) 352 (39) 313 (35) 347 (38) 410 (40) 426 (41) Mean age, years (range) 44 (18…”
New treatment regimes for virus-induced exacerbations of asthma
Edwards, M. R., Kebadze, T., Johnson, M. W., & Johnston, S. L. (2006) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2005.09.005 · Cited by 30 · see citing works
“Steroids so far have been disappointing in their ability to control symptoms in models of experimental RV challenge of asthmatics [15–18], and high-dose steroids remain only partially effective at controlling virus-induced exacerbations of asthma [19,20].”
BackgroundRecent developments in asthma management
Currie, G. P., Devereux, G. S., Lee, D. K. C., & Ayres, J. G. (2005) · BMJ · doi:10.1136/bmj.330.7491.585 · Cited by 30 · see citing works
Quon, B. S., FitzGerald, J. M., Lemière, C., Shahidi, N. C., & Ducharme, F. M. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007524.pub3 · Cited by 29 · see citing works
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NHG-Standaard Astma bij kinderen
Bindels, P., van der Wouden, J. C., Ponsioen, B. P., Brand, P. L. P., Salomé, P., Sachs, A. P. E., van Hensbergen, W., van Hasselt, P. A., Steenkamer, T. A., & Grol, M. H. (2009) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-6614-9_13 · Cited by 27 · see citing works
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Towards a personalised treatment approach for asthma attacks
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Asthma action plans are highly variable and do not conform to best visual design practices
Gupta, S., Wan, F. T., Ducharme, F. M., Chignell, M., Lougheed, M. D., & Straus, S. E. (2012) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2012.01.018 · Cited by 23 · see citing works
Beauchesne, M.-F., Levert, V., Tawil, M. E., Labrecque, M., & Blais, L. (2006) · Canadian Respiratory Journal · doi:10.1155/2006/458658 · Cited by 21 · see citing works
Huang, J., Lai, H., Zhao, W., Xia, D., Bai, C., Sun, M., Liu, J., Liu, J., Pan, B., Tian, J., et al. (2025) · Journal of Medical Internet Research · doi:10.2196/70450 · Cited by 20 · see citing works
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Long-acting β2-agonists in the management of asthma exacerbations
Hospenthal, M. A. C., & Peters, J. I. (2004) · Current Opinion in Internal Medicine · doi:10.1097/01.mcp.0000144501.42526.c9 · Cited by 19 · see citing works
Effect of Corticosteroids on Exacerbations of Asthma and Chronic Obstructive Pulmonary Disease
Calverley, P. M. A. (2004) · Proceedings of the American Thoracic Society · doi:10.1513/pats.200402-008ms · Cited by 19 · see citing works
“More recent carefully conducted randomized controlled trials have found no evidence of a reduction in the subsequent need for oral corticosteroids when this is done (14, 15 ).”
BackgroundTreating asthma: is there a place for leukotriene receptor antagonists?
Diamant, Z., & van der Molen, T. (2005) · Respiratory Medicine · doi:10.1016/j.rmed.2005.01.002 · Cited by 19 · see citing works
Drug therapy in the management of acute asthma
Carroll, W. D., & Lenney, W. (2007) · Archives of Disease in Childhood Education & Practice · doi:10.1136/adc.2006.107631 · Cited by 18 · see citing works
Advances in treating acute asthma exacerbations in children
Schramm, C. M., & Carroll, C. L. (2009) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e328329a52f · Cited by 17 · see citing works
Pharmacotherapy of Critical Asthma Syndrome: Current and Emerging Therapies
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“Most studies have not found that doubling the maintenance dose of the ICS during outpatient acute asthma exacerbations changes the pattern of the exacerbation [80, 105].”
BackgroundNHG-standaard Astma bij kinderen Tweede herziening
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White‐LED backlight control for motion‐blur reduction and power minimization in large LCD TVs
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Single-Inhaler Combination Therapy for Asthma
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Two for One: A Self‐Management Plan Coupled with a Prescription Sheet for Children with Asthma
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“Contrary to common practice, there is little evidence that step-up therapy with inhaled corticosteroids reduces the severity of exacerbations compared with maintaining a stable dose (12-14).”
BackgroundShort-term clinical outcomes of acute treatment of childhood asthma
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Immunoglobulin E Blockade in the Treatment of Asthma
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Approach to Infants and Children with Asthma
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“[46] 2004 Randomized controlled trial 290 Children aged greater than 13 years with an asthma diagnosis in the previous year Budesonide maintenance dose or double dose during an exacerbation 6 months Doubling the maintenance dose did not affect the exacerbation pattern”
- Authors
- FitzGerald, J. M.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- FitzGerald, J M
- ORCID
- FitzGerald, J M
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2004-07-01
- Volume
- 59
- Issue
- 7
- Pages
- 550-556
- ISSN
- 0040-6376 (ISSN-L)
- PMC
- PMC1747069
- OpenAlex
- W2117904842
- Cited by
- 193
- References
- 30
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 6 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 8 · 2014: 7 · 2013: 10 · 2012: 4
- FWCI
- 13.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- asthma exacerbations, budesonide, inhaled corticosteroids, treatment failure, systemic corticosteroids, asthma management
- MeSH terms
- Adolescent, Adult, Aged, Asthma, Bronchodilator Agents, Dose-Response Relationship, Drug, Double-Blind Method, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Patient Compliance, Peak Expiratory Flow Rate, Cohort Studies, Treatment Outcome, Budesonide
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