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Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations

Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations
Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations

BACKGROUND Asthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a plan for patients to manage their asthma (self-management plan), which included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate, would reduce the incidence of severe asthma exacerbations among adults and adolescents with asthma. METHODS We conducted a pragmatic, unblinded, randomized trial involving adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without addon therapy, and who had had at least one exacerbation in the previous 12 months. We compared a self-management plan that included an increase in the dose of inhaled glucocorticoids by a factor of 4 (quadrupling group) with the same plan without such an increase (non-quadrupling group), over a period of 12 months. The primary outcome was the time to a first severe asthma exacerbation, defined as treatment with systemic glucocorticoids or an unscheduled health care consultation for asthma. RESULTS A total of 1922 participants underwent randomization, of whom 1871 were included in the primary analysis. The number of participants who had a severe asthma exacerbation in the year after randomization was 420 (45%) in the quadrupling group as compared with 484 (52%) in the non-quadrupling group, with an adjusted hazard ratio for the time to a first severe exacerbation of 0.81 (95% confidence interval, 0.71 to 0.92; P = 0.002). The rate of adverse effects, which were related primarily to local effects of inhaled glucocorticoids, was higher in the quadrupling group than in the non-quadrupling group. CONCLUSIONS In this trial involving adults and adolescents with asthma, a personalized selfmanagement plan that included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate resulted in fewer severe asthma exacerbations than a plan in which the dose was not increased.

0028-4793
902-910
McKeever, Tricia
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Mortimer, Kevin
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Wilson, Andrew
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Walker, Samantha
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Brightling, Christopher
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Skeggs, Andrew
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Pavord, Ian D.
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Price, David
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Duley, Lelia
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Thomas, Mike
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Bradshaw, Lucy
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Higgins, Bernard
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Haydock, Rebecca
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Mitchell, Eleanor
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Devereux, Graham
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Harrison, Timothy
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McKeever, Tricia
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Mortimer, Kevin
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Wilson, Andrew
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Walker, Samantha
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Brightling, Christopher
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Skeggs, Andrew
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Pavord, Ian D.
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Price, David
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Duley, Lelia
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Thomas, Mike
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Bradshaw, Lucy
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Higgins, Bernard
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Haydock, Rebecca
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Mitchell, Eleanor
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Devereux, Graham
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Harrison, Timothy
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McKeever, Tricia, Mortimer, Kevin, Wilson, Andrew, Walker, Samantha, Brightling, Christopher, Skeggs, Andrew, Pavord, Ian D., Price, David, Duley, Lelia, Thomas, Mike, Bradshaw, Lucy, Higgins, Bernard, Haydock, Rebecca, Mitchell, Eleanor, Devereux, Graham and Harrison, Timothy (2018) Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations. New England Journal of Medicine, 378 (10), 902-910. (doi:10.1056/NEJMoa1714257).

Record type: Article

Abstract

BACKGROUND Asthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a plan for patients to manage their asthma (self-management plan), which included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate, would reduce the incidence of severe asthma exacerbations among adults and adolescents with asthma. METHODS We conducted a pragmatic, unblinded, randomized trial involving adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without addon therapy, and who had had at least one exacerbation in the previous 12 months. We compared a self-management plan that included an increase in the dose of inhaled glucocorticoids by a factor of 4 (quadrupling group) with the same plan without such an increase (non-quadrupling group), over a period of 12 months. The primary outcome was the time to a first severe asthma exacerbation, defined as treatment with systemic glucocorticoids or an unscheduled health care consultation for asthma. RESULTS A total of 1922 participants underwent randomization, of whom 1871 were included in the primary analysis. The number of participants who had a severe asthma exacerbation in the year after randomization was 420 (45%) in the quadrupling group as compared with 484 (52%) in the non-quadrupling group, with an adjusted hazard ratio for the time to a first severe exacerbation of 0.81 (95% confidence interval, 0.71 to 0.92; P = 0.002). The rate of adverse effects, which were related primarily to local effects of inhaled glucocorticoids, was higher in the quadrupling group than in the non-quadrupling group. CONCLUSIONS In this trial involving adults and adolescents with asthma, a personalized selfmanagement plan that included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate resulted in fewer severe asthma exacerbations than a plan in which the dose was not increased.

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Accepted/In Press date: 26 January 2018
e-pub ahead of print date: 3 March 2018
Published date: 8 March 2018

Identifiers

Local EPrints ID: 419638
URI: http://eprints.soton.ac.uk/id/eprint/419638
ISSN: 0028-4793
PURE UUID: 89c365a2-e9d4-4d06-b8cd-65ccb0f609bd

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Date deposited: 17 Apr 2018 16:30
Last modified: 21 Jan 2020 05:02

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Contributors

Author: Tricia McKeever
Author: Kevin Mortimer
Author: Andrew Wilson
Author: Samantha Walker
Author: Christopher Brightling
Author: Andrew Skeggs
Author: Ian D. Pavord
Author: David Price
Author: Lelia Duley
Author: Mike Thomas
Author: Lucy Bradshaw
Author: Bernard Higgins
Author: Rebecca Haydock
Author: Eleanor Mitchell
Author: Graham Devereux
Author: Timothy Harrison

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