Should You Increase Asthma Inhaler Use?

Not always a recipe for success

Is increasing inhaled steroids during asthma flare-ups appropriate?

In my practice I often encounter children with asthma on low dose inhaled steroids whose parents have been advised to double their dose when their children become unwell.

Recent Studies Raise Doubt

Recently, two well-conducted clinical trials published in a top-ranked medical journal examined whether quadrupling your inhaled steroid dose at the beginning of a flare-up was helpful.

Study One

The first study (involving children aged 5 to 11 years of age) found that

  • increasing inhaled steroids was of no benefit and
  • had the potential to cause harm in terms of linear growth.  

Study Two

The second study examined the same question in adolescent children (16 years and up) and adult patients. In contrast this study revealed

  • a modest benefit, however
  • once again the rate of adverse events was higher in the group who increased their inhaled steroids.

Should You Increase Your Inhaler?

In Summary, the take-home message from these studies is that the practice of increasing inhaled steroids during an asthma flare-up is

  • not beneficial and
  • may cause harm.

Further research should be directed toward understanding more clearly why asthma flare-ups happen in the first place.

References

  1. Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations. N Engl J Med. 2018 Mar 8;378(10):891-901

  2. Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations. N Engl J Med. 2018 Mar 8;378(10):902-910.