Double-Dosing Inhalants For Asthma Not Effective For Most

But Helpful For Patients Who Fail To Use Inhalers Regularly

< January 28, 2004 > -- The longstanding practice of treating an asthma flareup by doubling the normal dose of an inhaled steroid does not work for most patients, a new study finds.

Patients who took twice their customary dose for two weeks when their asthma symptoms worsened did no better than those who continued to take the usual dose, says a report in the medical journal The Lancet.

Asthma is a chronic, inflammatory lung disease involving recurrent breathing problems.

Asthma may resemble other respiratory problems such as emphysema, bronchitis, and lower respiratory infections. It is under-diagnosed - many people with the disease do not know they have it.

Sometimes the only symptom of asthma is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise. Some persons believe they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma.

The study by British physicians included 390 people using inhaled steroids regularly to control their asthma symptoms.

They were told to add a second inhaler when their symptoms worsened. One hundred ninety-two patients were given inhalers containing a steroid, and 198 were given inhalers with a placebo (an inactive substance).

Study Examines Different Scenarios

The researchers report that there was no significant difference in symptoms for those who got the extra inhaled drug, compared to those who got the placebo.

Doubling the dose is an option for some patients - those who do not follow their recommended self-treatment measures faithfully, says Dr. Tim W. Harrison, a physician at Nottingham City Hospital.

But because the participants in the study knew they were in a controlled trial, they were more likely to follow treatment recommendations, making the added dose less important, he says.

"What we are specifically saying is that if asthma is well-controlled and all of a sudden takes a dive because of an infection or another problem, doubling the dose in that setting will not be as effective in avoiding complications," Dr. Harrison says.

Experts Have Learned Through Experience

Dr. Hugh H. Windom, an associate clinical professor of immunology at the University of South Florida and a spokesman for the American Academy of Allergy, Asthma and Immunology, agrees with that assessment.

Only 10 percent of the people in the study experienced flareups, lower than expected in the general population of people with asthma, Dr. Windom says.

"These were people much more attuned to what was going on" than many asthma patients," he says.

Dr. Windom adds that doubling the dose of an inhaled steroid remains an option, but only for patients who do not keep their symptoms under control.

There have been "numerous" studies done in emergency rooms and clinical practice showing that doubling the dose is not effective for most asthma patients, says Dr. Michael S. Blaiss, president of the American Academy of Allergy, Asthma and Immunology.

Still, he says, "I've seen it done. You see a lot of children being given increased doses of inhaled steroids for an acute asthma. But you can always tell that it doesn't work."

Inhaling more of a steroid is ineffective because the medication does not reach the target tissue, the delicate lining of the lungs, Dr. Blaiss says.

"Once you've got a fair amount of inflammation in the lungs, you're not getting penetration," he says.

Always consult your physician for more information.

Find a Physician at
St. John's Mercy or call our Physician Referral Service at 314-FOR-DOCS.

What Is Asthma?

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health defines asthma as a chronic disease that affects an individuals airways, which are the tubes that carry air in and out of the lungs.

If a person has asthma, the NHLBI states, the inside walls of the airways are inflamed. The inflammation makes the airways very sensitive, and they tend to react strongly to things to which a person is allergic or finds an irritant. When the airways react, they get narrower and less air flows through to lung tissues. This causes symptoms like wheezing, coughing, chest tightness, and trouble breathing.

Asthma cannot be cured, but for most patients it can be controlled so that a person has only minimal and infrequent symptoms and can live an active life.

Controlling asthma means staying away from things that bother your airways and taking medications as directed by your physician. By controlling asthma every day, serious symptoms can be prevented. 

The NHLBI reports that worsening asthma symptoms is called an asthma episode or attack. In an asthma attack, muscles around the airways tighten up, making the airway openings narrower so less air can flow through.

Inflammation increases and the airways become more swollen and narrow. Cells in the airways also make more mucus than usual. This extra mucus also narrows the airways.

These changes cause the symptoms of asthma and make it harder to breathe. Asthma attacks are not all the same; some are worse than others. In a severe asthma attack, the airways can close so much that not enough oxygen gets to vital organs. This condition is a medical emergency. People can die from severe asthma attacks.

Always consult your physician for more information.

Online Resources

Allergy and Asthma Foundation of America

American Academy of Allergy, Asthma & Immunology

American Lung Association

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Heart, Lung, and Blood Institute

National Institutes of Health (NIH)