A temporary quadrupling of inhaled glucocorticoids dose at first signs of deterioration, reduces the number of severe asthma exacerbations, suggest the results of the Fourfold Asthma Study (FAST).
The study, led by the University of Nottingham, included 1922 adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without add-on therapy, and who had had at least one exacerbation in the previous 12 months. Participants were randomised to a self-management plan that included a 4-fold increased dose of inhaled glucocorticoids or the same plan without increased dose, over a period of 12 months. The primary outcome was the time to first severe asthma exacerbation, defined as treatment with systemic glucocorticoids or an unscheduled healthcare consultation for asthma.
In the year after randomisation, the number of participants who had a severe asthma exacerbation was 45% in the quadrupling group compared with 52% in control group, showing an adjusted HR for time to first severe exacerbation of 0.81 (95% CI, 0.71-0.92; P=.002).
33% of participants in the quadrupling group vs 40% in control group started systemic glucocorticoids. In the quadrupling group, 41% had an unscheduled healthcare consultation compared with 47% in the control group.
Presenting the findings in the New England Journal of Medicine, the authors estimate the number of patients needed to be provided with such a self-management plan in order to prevent one severe asthma exacerbation is 15 (95% CI, 9-43).