Serious asthma attacks reduced by temporary quadrupling of steroid inhaler

Serious asthma attacks in adults can be reduced by a temporary but significant increase in the dose of inhaled steroids during asthma worsenings, according to a new national study led by the NIHR Leicester Biomedical Research Centre.

Previous research in found that doubling the dose of inhaled steroids during worsening asthma did not prevent the frequency of serious attacks, so this new NIHR-funded clinical trial was set up to see if quadrupling the dose had a more beneficial effect.

The Fourfold Asthma Study (FAST) – published in the New England Journal of Medicine – compared two asthma self-management plans in a large trial involving nearly 2000 patient volunteers in England and Scotland. Around half the patients were randomly assigned to the plan that prescribed a quadrupling of inhaled steroid during periods of worsening asthma and the other half followed the current standard self-care plan over a period of 12 months.

The study showed that the participants in the quadrupling group had a 20 per cent reduction in severe asthma attacks compared with the usual care group and they also had fewer asthma-related hospital admissions, as only 3 patients in the quadrupling group were admitted to hospital compared with 18 in the usual care group.

Professor Chris Brightling, co-author of the study and NIHR senior investigator in respiratory disease at the NIHR Leicester Biomedical Research Centre and our Department of Infection, Immunity and Inflammation said: “Working with multiple centres in acute hospital trusts and GP practices across the country has led to a study with immediate impact on how patients with asthma self-manage to prevent further exacerbations. NIHR funded studies are about taking research findings smoothly from clinical trials to routine practice for the benefit of patients through rapid adoption into national guidelines.”

The NIHR Leicester Biomedical Research Centre is a partnership between Leicester’s Hospitals, the University of Leicester and Loughborough University.