Safety, Efficacy of Quintupled Inhaled Glucocorticoid Dose for Asthma Exacerbation Management

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology, taking place in Orlando, Florida. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI/WAO 2018.

ORLANDO — Asthma exacerbations in children with mild to moderate persistent asthma were not more effectively treated with a quintupled dose of inhaled glucocorticoid medications, according to a new study.

The research was presented at the 2018 American Academy of Allergy, Asthma & and Immunology/World Allergy Organization (AAAAI/WAO) Joint Congress and simultaneously published in the New England Journal of Medicine.

Researchers from the National Heart, Lung, and Blood Institute AsthmaNet conducted a study of 254 children aged 5 to 11 years with mild to moderate persistent asthma (Step-up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations [STICS]; ClinicalTrials.gov Identifier: NCT02066129). The researchers assessed the safety and efficacy of administering increased doses of inhaled glucocorticoids as an early treatment for asthma exacerbation.

Participants underwent 48 weeks of treatment on a low maintenance dose of inhaled glucocorticoid (fluticasone propionate, 44 μg per inhalation twice daily). Electronic diaries were completed daily throughout the study, and Childhood Asthma Control Test scores >18 were assessed. Study participants were randomly assigned 1:1 to either continue the low-dose therapy or to receive a high-dose course of therapy (220 μg per inhalation, 2 inhalations twice daily) for 7 days following early signs of asthma exacerbation (n=127 in each group).

The primary study outcome was the number of asthma exacerbations per year. Secondary outcomes included the number of emergency department or urgent care visits per year.

In total, 38 and 30 participants in the high- and low-dose groups experienced at least 1 severe asthma exacerbation and were treated with systemic glucocorticoids. Rate of exacerbations in the high-dose group was 0.48 exacerbations per year (95% CI, 0.33-0.70); the rate in the low-dose group was 0.37 (95% CI, 0.25-0.55; relative rate between groups: 1.3; 95% CI, 0.8-2.1; P =.30).

Time to first severe asthma exacerbation did not differ between groups (P =.20), nor did the rate of asthma-related emergency department or urgent care visits (relative rate: 1.3; 95% CI, 0.8-2.4; P =.30).

The researchers cautioned that these findings are specific to school-aged children who are regularly treated with daily low-dose inhaled glucocorticoids, with demonstrated good medication adherence.

“[I]n children with mild to moderate persistent asthma treated with daily inhaled glucocorticoids, quintupling the dose of inhaled glucocorticoids at the early signs of loss of asthma control did not result in a lower rate of exacerbations than continuous use of the daily maintenance dose,” the researchers concluded.

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Reference

Jackson DJ. Bacharier LB, Mauger DT, et al; for the National Heart, Lung, and Blood Institute AsthmaNet. Quintupling inhaled glucocorticoids to prevent childhood asthma exacerbations [published online March 3, 2018]. N Engl J Med. doi:10.1056/NEJMoa1710988