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Am. J. Respir. Crit. Care Med., Volume 158, Number 1, July 1998, 121-125

Starting with a Higher Dose of Inhaled Corticosteroids in Primary Care Asthma Treatment

THYS van der MOLEN, BETTY MEYBOOM-DE JONG, HELMA H. MULDER, and DIRKJE S. POSTMA

Department of General Practice, University of Groningen, and Department of Pulmonary Diseases, University Hospital, Groningen, The Netherlands

New British guidelines on the treatment of asthma () advocate starting with a higher dose of inhaled corticosteroids in newly detected asthma patients. We investigated whether initiating inhaled steroid treatment with a higher dose is clinically more effective than a lower dose in steroid naive patients with asthma. The study had a 13-wk randomized, double-blind, parallel design: 1-mo treatment with 400 µg budesonide twice a day, or 100 µg budesonide twice a day by dry powder inhaler, and follow-up treatment period of 2 mo with 200 µg budesonide once daily for all patients. Forty patients started with 400 µg budesonide twice daily, 44 with 100 µg budesonide twice daily. Mean age was 32 yr, baseline FEV1 value 84% predicted, reversibility 9% from baseline, and mean bronchodilator use 1.6 inhalations/d in the run-in period. After 4 wk of treatment with 400 µg and 100 µg budesonide twice daily mean morning peak expiratory flow (PEF) increased 27 L/min (SD 50), and 38 L/ min (SD 53), respectively (p = 0.30); mean symptom score improved from 1.1 to 0.6 and from 1.1 to 0.5. These effects were maintained in the 2 mo follow-up. This study suggests that starting inhaled corticosteroids at a higher dose is not superior to a lower dose in the treatment of newly detected asthma. van der Molen T, Meyboom-de Jong B, Mulder HH, Postma DS. Starting with a higher dose of inhaled corticosteroids in primary care asthma treatment.




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