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Inhaled corticosteroids, a practical perspective in adults |
Introduction
The key goal of asthma management with inhaled corticosteroids (ICS) is to achieve optimal asthma control with the lowest effective dose. The dose of ICS needed to gain control of asthma should be that which is most appropriate to the severity of the underlying disease. There is now level 1 evidence that shows that most clinical benefit of ICS is derived from low to moderate doses, with little or no further benefit at higher doses, Regular review, of course, is important to enable proper assessment and maintenance.
Low, medium, high doses?
Total daily dose
Low: Up to 250mcg BDP-HFA or FP; up to 400mcg BUD
Medium: Up to 500mcg BDP-HFA or FP; up to 800mcg BUD
High: 500mcg or above BDP-HFA or FP; 800mcg or above BUD
(BDP-HFA = beclomethasone dipropionate; FP = fluticasone propionate; BUD = budesonide)
Efficacy of low dose inhaled corticosteroids
Evidence suggests that optimal asthma control can be achieved with lower doses than were previously used, it has been shown that doses less than 500 mcg fluticasone are very effective in controlling symptoms and improving lung function, assessed regularly using spirometry.
Minimum effective dose is achieved through ongoing assessment; asthma control should be re-assessed at every visit.
Combination therapy
Consider adding LABA in any patient who is sub-optimally controlled on ICS dose of 200-250mcg BDP-HFA or 400 mcg BUD daily.
If asthma is optimally controlled on combination treatment, consider withdrawing the LABA once the ICS dose has been reduced to 100-250mcg BDP-HFA or 200-400 mcg BUD daily
This article is a précis of a larger document. “Inhaled Corticosteroids: a Practical Perspective” is available from the National Asthma Council of Australia http://www.NationalAsthma.org.au/papers/ics/adjustment.asp
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