What has changed?

The recommendations for higher doses of ICS were a feature of asthma guidelines in the years before long-acting beta₂ agonists (LABAs) were introduced. In addition, past recommendations for higher doses were not based on evidence of dose-response relationships for efficacy or side effects. As a result, prescribers tended to use higher than necessary doses for maintaining asthma control.

There is now clear evidence that low doses of ICS are effective for maintaining control of asthma symptoms in most patients and there is little need to use high doses.² Although studies show some dose-response benefit at ICS doses over 500 mcg/day FP or equivalent, the side effect impact is now better understood, and these doses can be avoided by adding a LABA in most symptomatic patients.

However, data on prescribing patterns in Australia suggest that:

• Australian prescribers have used higher doses of ICS than clinicians in Europe and the United States.⁸
• A substantial proportion of patients in whom ICS maintenance therapy is indicated have not been prescribed ICS treatment.⁹