A recent paper published in The Journal of Allergy and Clinical Immunology this month found no evidence that a step-up to high-dose ICS is effective in preventing future asthma exacerbations.
The Medical Republic published these findings on 21 November 2022 in the article ‘No breath of relief for asthma patients’, with our spokesperson Professor Peter Wark highlighting that GP’s need to be aware of the following:
- “These new findings call into question the current approach of stepping up to high-dose inhaled corticosteroids, based on worsened asthma symptoms or exacerbations alone."
- Most people with asthma should be able to achieve good asthma control on low dose or medium dose inhaled corticosteroids, alone or in combination with a long acting beta agonists. Either in a fixed dose or as maintenance and reliever therapy with inhaled corticosteroid/formoterol.
- Few people benefit from stepping up to high dose corticosteroids. Those who continue to have poor asthma control and uncontrolled inflammation (in this study measured by elevated blood eosinophils) may be the exception.
- “The NAC guidelines look at phenotypes in step five of treatment. The results from these findings (published in November 2022) suggest it needs to be considered earlier.”
- “GPs should instead look at phenotypes in step four of treatment – identify the nature of the problem and the patient’s phenotype (high type 2 inflammation, high blood eosinophils or exhaled nitric oxide) might benefit from high dose inhaled corticosteroids, but there is strong evidence now that a referral to a specialist for a biologic is very effective in these patients.”
- In those with symptoms, especially with persistent airflow obstruction on spirometry, but not evidence of type 2 inflammation, the addition of a LAMA (long acting antimuscarinic) is a better option.
Read the article ‘No breath of relief for asthma patients’ here
Access the paper, ‘Effect of stepping up to high-dose inhaled corticosteroids in patients with asthma: UK Database Study’ here
Access the Australian Asthma Handbook
Version 2.2 is the latest version of the Australian Asthma Handbook and was published in April 2022.