(Ivanhoe Newswire) -- Recommendations to double the dosage of inhaled steroids at the start of asthma attacks are challenged by research findings in the latest issue of The Lancet. This approach is widely advocated but investigators say it is of unproven value.

Researchers from the Department of Respiratory Medicine at Nottingham City Hospital in England studied 390 asthma patients, age 16 or older, who are at risk of an asthma exacerbation and who take an inhaled corticosteroid each day. Patients monitored their asthma for up to one year and were instructed to add an extra inhaler (either steroid or placebo) for two weeks when their asthma control deteriorated.

Results of the study show there was no statistically significant difference in the proportion of people requiring oral steroids between the active and placebo groups. In both groups around 12 percent of patients required oral steroids. In the active group, 22 of the 192 participants started prednisolone compared to 24 of 198 participants in the placebo group. There was also no statistically significant difference in the proportion of patients who visited their general practitioner or who were prescribed antibiotics.

Investigators say one reason doubling the dose is ineffective is the slow onset of inhaled corticosteroid action compared with the rapid deterioration in asthma control may not leave enough time for inhaled corticosteroids to prevent an exacerbation. Lead researcher Tim Harrison recommends, "Until more data are available, patients should continue to take a short course of oral steroids for asthma exacerbations."

SOURCE: The Lancet, 2004;363:271-275

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