Optimal starting dose of inhaled corticosteroids in adult asthma: why has it taken so long?

Why has it taken so long to learn what we still don't know?

Initial starting dose of inhaled corticosteroids in adults with asthma: a systematic review.

BACKGROUND Asthma guidelines vary in their recommendations for the initial dose of inhaled corticosteroid (ICS) in asthma. A systematic review of the literature was conducted to establish the optimal starting dose of ICS for asthma in adults. METHODS Randomised controlled trials comparing two doses of the same ICS in adults with asthma and no concomitant inhaled or oral corticosteroid were as...

Starting with a higher dose of inhaled corticosteroids in primary care asthma treatment.

New British guidelines on the treatment of asthma (9) 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 treatmen...

Starting inhaled corticosteroids in asthma: when, how high, and how long.

In the past 10 years many intervention studies have tried to define the optimal dose of inhaled corticosteroids in the treatment of patients with mild or moderate asthma. In all but the largest studies it has been very difficult to show a dose related effect on common outcome parameters such as symptoms and lung function. Relevant differences not only in end-parameters but also in study designs...

Moderate dose inhaled corticosteroids plus salmeterol versus higher doses of inhaled corticosteroids in symptomatic asthma.

BACKGROUND There is uncertainty as to the dose of inhaled corticosteroids (ICS) at which to start concomitant long acting beta agonist (LABA) treatment in patients with asthma not adequately controlled by ICS alone. METHODS A meta-analysis was carried out of randomised, double blind clinical trials that compared the efficacy of adding salmeterol to moderate doses of ICS (fluticasone propionat...