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LetterLetters

Is there adequate evidence for quadrupling inhaled corticosteroid doses?

James McCormack
Canadian Family Physician May 2019; 65 (5) 313-314;
James McCormack
Vancouver, BC
PharmD
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    Table 1.

    Details and results of 2 studies in adults with asthma that examined the effect of quadrupling inhaled corticosteroids as part of an asthma action plan: The Oborne et al study cohort was about 54 y of age and 39% male; the McKeever et al study cohort was about 56 y of age and 33% male.

    STUDY GROUPOBORNE ET AL,2 2009 (N = 403)MCKEEVER ET AL,3 2018 (N = 1922)
    STARTED ORAL CSADVERSE EVENTS IN THOSE WHO STARTED THE INHALER*SEVERE EXACERBATION†STARTED ORAL CSHOSPITALIZATION FOR ASTHMATHOSE WHO REACHED ZONE 2 OF THEIR SELF-MANAGEMENT PLAN ‡
    NONSERIOUS ADVERSE EVENTSORAL CANDIDIASIS OR DYSPHONIA
    Placebo or control§14%8% (3 of 38)52%40%1.8%2% (10 of 552)1.6% (9 of 552)
    Quadruple dose9%‖16% (9 of 56)45%33%0.3%¶7% (41 of 562)6.4% (36 of 562)
    • CS—corticosteroids.

    • ↵* 23% of the cohort.

    • ↵† Treatment with oral CS or an unscheduled health care consultation for asthma.

    • ↵‡ 58% of the cohort.

    • ↵§ Placebo group in the study by Oborne et al2 and control group in the study by McKeever et al.3

    • ↵‖ Not statistically different; however, in those patients who actually started the study inhaler there was a statistically significant reduction: 50% (19 of 38) versus 21% (12 of 56).

    • ↵¶ No statistical tests reported.

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Canadian Family Physician: 65 (5)
Canadian Family Physician
Vol. 65, Issue 5
1 May 2019
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Is there adequate evidence for quadrupling inhaled corticosteroid doses?
James McCormack
Canadian Family Physician May 2019, 65 (5) 313-314;

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