High-dose steroids don’t prevent asthma flare-ups

High doses of glucocorticoids are not effective in preventing life-threatening asthma flare-ups, according to a landmark study published in The New England Journal of Medicine (NEJM).

Professor Philip Bardin

Glucocorticoids are anti-inflammatory medications used in many everyday prescription asthma puffers, such as turbuhalers or accuhalers.

Hudson Institute research group head, Professor Phil Bardin was invited by the NEJM to assess the evidence for this therapy, based on two recent asthma clinical trials.

“Inhaled glucocorticoids are pivotal to achieving asthma control in children and adults but despite their use, many patients with asthma still have flare-ups,” said Professor Bardin, Director Monash Lung and Sleep and Head of the Respiratory and Lung Research Group at Hudson Institute.

“Acute flare ups of asthma are detrimental because they adversely affect quality of life, lung function and health care costs and have the potential to end in death.

“Everyone agrees that preventing these exacerbations is a priority in asthma care,” Professor Bardin said.

Professor Bardin said asthma specialists have long thought that more aggressive use of inhaled glucocorticoids can prevent asthma worsening (flare ups) if initiated at the first signs of deterioration.

Professor Bardin found good evidence that children, in particular, receive no significant benefit from high-dose inhaled glucocorticoids in terms of their likelihood of having an asthma attack. However, the medications are very important and effective in treating chronic asthma.

“The evidence indicates that substantial escalation of regularly used inhaled glucocorticoids, even by a factor of four or five, fails to prevent most asthma flare ups,” Professor Bardin said.

The editorial invitation by the prestigious journal is due to Professor Bardin and his team’s significant research into asthma at the Monash Health Translation Precinct (MHTP).

“The invitation to contribute to the NEJM on this topic is a testament to our global reputation built upon the outstanding clinical research done at Monash over many years,” Professor Bardin said.

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