BMJ  2003;326:1115 (24 May), doi:10.1136/bmj.326.7399.1115

Paper

Stepping down inhaled corticosteroids in asthma: randomised controlled trial

¹ Department of General Practice, University of Glasgow, Glasgow G12 0RR, ² Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, ³ Department of Research and Development, Stobhill Hospital, Glasgow G21 3UT, ⁴ Department of Respiratory Medicine, University of Glasgow, Western Infirmary, Glasgow G11 6NT

Objectives To determine whether the dose of inhaled corticosteroids can be stepped down in patients with chronic stable asthma while maintaining control. Design One year, randomised controlled, double blind, parallel group trial.

Setting General practices throughout western and central Scotland.

Participants 259 adult patients with asthma receiving regular treatment with inhaled corticosteroids at high dose (mean dose 1430 µg beclomethasone dipropionate).

Interventions Participants were allocated to receive either no alteration to their dose of inhaled corticosteroid (control) or a 50% reduction in their dose if they met criteria for stable asthma (stepdown).

Main outcome measures Comparison of asthma exacerbation rates, asthma related visits to general practice and hospital, health status measures, and corticosteroid dosage between the two groups.

Results The proportions of subjects with asthma exacerbations were not significantly different (stepdown 31%, control 26%, P=0.354). Similarly, the numbers of visits to general practice or hospital and the disease specific and generic measures of health status over the one year period were not significantly different. On average the stepdown group received 348 µg (95% confidence interval 202 µgto494 µg) of beclomethasone dipropionate less per day than the controls (a difference of 25%), with no difference in the annual dose of oral corticosteroids between the two treatment regimens.

Conclusions By adopting a stepdown approach to the use of inhaled steroids at high doses in asthma a reduction in the dose can be achieved without compromising asthma control.

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Rapid Responses:

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Alternatives to Inhalers

Sharon J Williams
bmj.com, 23 May 2003 [Full text]

Asthma diagnosis

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The impact of illustrations must be considered

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Further to my response

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Evidence of equivalence rather than difference

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