Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations

Inhaled glucocorticoids may prevent a mild loss of asthma control from becoming a full exacerbation. In a randomized trial involving children, quintupling the daily dose at early signs of loss of asthma control did not result in a lower rate of severe asthma exacerbations. Increases in symptoms may occur before exacerbations fully develop. In two trials, when symptoms occurred, the dose of inhaled glucocorticoids was increased by a factor of 5 (pediatric trial) or 4 (adult trial). There was no benefit, and perhaps some harm, in children, and a modest benefit in adults.