Short-term high-dose corticosteroids did not prevent severe asthma flare-ups

A new study published in the New England Journal of Medicine showed that temporarily increasing the dosage of inhaled steroids in children when asthma symptoms begin to worsen does not effectively prevent severe flare-ups. It may also be associated with slowing a child’s growth, which challenges this common medical practice.

The study was presented at the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology and the World Allergy Organization, held March 2-5 in Orlando, FL.

To prevent asthma flare-ups in children, many health professionals recommend increasing the dose of inhaled steroids from low to high at early signs of symptoms, such as coughing, wheezing, and shortness of breath. Prior to this study, this strategy had not been rigorously tested for safety and efficacy in children with mild-moderate asthma.

“These findings suggest that a short-term increase to high-dose inhaled steroids should not be routinely included in asthma treatment plans for children with mild-moderate asthma who are regularly using low-dose inhaled corticosteroids,” said study leader Daniel Jackson, MD, associate professor of pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, and an expert on childhood asthma. “Low-dose inhaled steroids remain the cornerstone of daily treatment in affected children.”

The study included 254 children from 5 to 11 years of age with mild-to-moderate asthma for nearly a year. All children were treated with low-dose inhaled corticosteroids (two puffs from an inhaler twice daily). At the earliest signs of asthma flare-up—which some children experienced multiple times throughout the year—the researchers continued giving low-dose inhaled steroids to half of the children and increased to high-dose inhaled steroids (five times the standard dose) in the other half, twice daily for seven days during each episode.

Although the children in the high-dose group had 16% more exposure to inhaled steroids than those in the low-dose group, they did not experience significantly fewer severe flare-ups. The number of asthma symptoms, the length of time until the first severe flare-up, and the use of albuterol were similar between the two groups.

Unexpectedly, the investigators found that the rate of growth of children in the short-term high-dose group was about 0.23 cm per year less than the rate for children in the low-dose group, even though the high-dose treatments were given only about 2 weeks per year on average.

The growth difference was small, but the finding reaffirms previous studies showing that children who take inhaled corticosteroids for asthma may experience a small negative impact on their growth rate. The researchers cautioned that more frequent or prolonged high-dose steroid use in children might increase this adverse effect.

The study did not include children with asthma who do not take inhaled steroids regularly, nor did it include adults.

“This study allows caregivers to make informed decisions about how to treat their young patients with asthma,” said James Kiley, PhD, director of the National Heart, Lung, and Blood Institute’s (NHLBI) Division of Lung Diseases, which funded the study. “Trials like this can be used in the development of treatment guidelines for children with asthma.”

To read more about this study, click here. 

This study was supported by NHLBI grants. The NHLBI-funded study, Step Up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS), is part of the NHLBI AsthmaNet program, a nationwide clinical research network that explores new approaches in treating asthma from childhood to adulthood.