Home > News

FRIDAY, Jan. 23 (HealthDayNews) -- The longstanding practice of treating an asthma flareup by doubling the normal dose of an inhaled steroid doesn't work for most patients, a new British study finds.

Patients who took twice their customary dose for two weeks when their asthma symptoms worsened did no better than those who continued to take the usual dose, says a report in the Jan. 24 issue of The Lancet.

The study by physicians at Nottingham City Hospital included 390 people using inhaled steroids regularly to control their asthma symptoms. They were told to add a second inhaler when their symptoms worsened. One hundred ninety-two patients were given inhalers containing a steroid, and 198 were given inhalers with a placebo.

There was no significant difference in symptoms for those who got the extra inhaled drug, compared to those who got the placebo, the researchers report.

In 1995, British health officials issued guidelines that recommended doubling the dose. But they revised those last year, recommending against the double dose.

The Nottingham study was started before the issuance of those revised guidelines. It was also done because of a lack of evidence to substantiate the new guidelines, says trial leader Dr. Tim W. Harrison, a consultant respiratory physician at Nottingham.

"Our study came about trying to find enough evidence," he says. "Only since we started the study have the guidelines been more critical."

Doubling the dose is an option for some patients -- those who don't follow their recommended self-treatment measures faithfully, Harrison says. But because the participants in the study knew they were in a controlled trial, they were more likely to follow treatment recommendations, making the added dose less important, he says.

"What we are specifically saying is that if asthma is well-controlled and all of a sudden takes a dive because of an infection or another problem, doubling the dose in that setting will not be as effective in avoiding complications," Harrison says.

Dr. Hugh H. Windom, an associate clinical professor of immunology at the University of South Florida and a spokesman for the American Academy of Allergy, Asthma and Immunology, agrees with that assessment.

Only 10 percent of the people in the study experienced flareups, lower than expected in the general population of people with asthma, Windom says. "These were people much more attuned to what was going on" than many asthma patients, he says.

Windom adds that doubling the dose of an inhaled steroid remains an option, but only for patients who don't keep their symptoms under control.

That's something that specialists know but some family doctors might not, says Dr. Michael S. Blaiss, president of the American Academy of Allergy, Asthma and Immunology.

There have been "numerous" studies done in emergency rooms and clinical practice showing that doubling the dose is not effective for most asthma patients, says Blaiss, who is clinical professor of pediatrics and medicine at the University of Tennessee Health Science Center.

Still, he says, "I've seen it done. You see a lot of children being given increased doses of inhaled steroids for an acute asthma. But you can always tell that it doesn't work."

Inhaling more of a steroid is ineffective because the medication doesn't reach the target tissue, the delicate lining of the lungs, Blaiss says.

"Once you've got a fair amount of inflammation in the lungs, you're not getting penetration," he says.

More information

To learn more about asthma, visit the National Library of Medicine and the Asthma and Allergy Foundation of America.

(SOURCES: Michael S. Blaiss, clinical professor, pediatrics and medicine, University of Tennessee Health Science Center, Memphis; Tim W. Harrison, M.D., consultant respiratory physician, Nottingham City Hospital, England; Hugh H. Windom, M.D., associate clinical professor of immunology, University of South Florida, and a spokesman for the American Academy of Allergy, Asthma and Immunology; Jan. 24, 2004, The Lancet)

Copyright © 2004 ScoutNews, LLC. All rights reserved.