High dose versus low dose inhaled corticosteroid as initial starting dose for asthma in adults and children

The Cochrane Database of Systematic Reviews
H Powell, P G Gibson

Abstract

Inhaled corticosteroids (ICS) form the basis of maintenance therapy in asthma and their efficacy is well established. However, the optimal starting dose of ICS is not clearly established. Recent reviews demonstrate a relatively flat efficacy curve for ICS and increasing side effects with increasing ICS doses. High doses are frequently prescribed and there are now reports of significant side effects occurring with high dose ICS use. These issues demonstrate the need to establish the optimal starting dose of ICS in asthma. To establish the optimal starting dose of ICS by evaluating the efficacy of initial high dose ICS with low dose ICS in subjects with asthma, not currently on ICS. We searched the Cochrane Airways Group trials register and reference lists of articles. Date of last search: January 2003 Randomised controlled trials of two different doses of the same ICS in adults and children with asthma with no concomitant ICS or OCS. Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for confirmation. Trials were analysed according to the following ICS dose comparisons: step down vs constant dose ICS (n=7); high vs moderate (n=11); high vs low (n=9); moderate vs low (n...Continue Reading

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