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Title: Quadrupling Inhaled Gluococorticoid Dose To Abort Asthma Exacerbations
Authors: McKeever, Tricia
Mortimer, Kevin
Wilson, Andrew
Walker, Samantha
Brightling, Christopher
Skeggs, Andrew
Parvord, Ian
Price, David
Duley, Lelia
Thomas, Mike
Bradshaw, Lucy
Higgins, Bernard
Haydock, Bernard
Mitchell, Eleanor
Devereux, Graham
Harrison, Timothy
First Published: 8-Mar-2018
Publisher: Massachusetts Medical Society
Citation: New England Journal of Medicine, 2018, 378, pp. 902-910
Abstract: Background Asthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a self-management plan, which included a temporary quadrupling of the dose of inhaled glucocorticoid when asthma control started to deteriorate, would reduce severe asthma exacerbations in adults with asthma. Methods A pragmatic, unmasked, randomized trial in adults with asthma, treated with inhaled glucocorticoids with or without additional add-on therapy and one or more exacerbation in the previous 12 months. We compared a self-management plan that included a four-fold increase in inhaled glucocorticoid dose with the same plan without an increase in glucocorticoid, over 12 months. The primary outcome was time to first severe asthma exacerbation, defined as treatment with systemic glucocorticoids or unscheduled healthcare consultation for asthma. Results 1922 participants were randomized of whom 1871 contributed to the primary analysis. The number of participants having a severe asthma exacerbation in the year after randomization was 484 (51.6%) in the non-quadrupling group and 420 (45.0%) in the quadrupling group, with an adjusted hazard ratio for time to first severe exacerbation of 0.81 (95% confidence interval 0.71 to 0.92, p-value 0.002). Adverse effects, primarily related to local effects of inhaled glucocorticoids, were increased in the quadrupling group. Conclusion Severe exacerbations of asthma were reduced in adults with asthma with a personalized self-management plan that included a temporary four-fold increase in inhaled glucocorticoid dose when asthma control started to deteriorate.
DOI Link: 10.1056/NEJMoa1714257
ISSN: 0028-4793
eISSN: 1533-4406
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2018, Massachusetts Medical Society. Deposited with reference to the publisher’s open access archiving policy.
Description: The file associated with this record is under embargo until 6 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.
Appears in Collections:Published Articles, Dept. of Health Sciences

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