Step-down and step-up therapy in moderate persistent asthma.
BACKGROUND
A step-down therapy may be more beneficial for the management of asthma than a step-up therapy.


METHODS
Eighty-two asthmatic patients with moderate persistent asthma were enrolled in the study and randomized into three groups. One group of patients received 400 microg/day of beclomethasone dipropionate (BDP) for 4 weeks and then 800 microg/day for another 4 weeks (step-up group). The other two groups of patients received 1,200 microg/day of BDP for 4 weeks with or without short-term oral steroid (prednisolone, 0.5 mg/day for 1 week) and then 800 microg/day for another 4 weeks (step-down group). Severe exacerbation of asthma, asthma symptoms, respiratory function and rescue use of inhaled beta(2)-agonists were monitored. If asthma was well controlled, the dose of BDP was decreased every 3 months and if asthma was exacerbated, the dose of BDP was increased until 8 months after the initial treatment.


RESULTS
Twenty-two patients during the run-in period, 4 patients in the step-up group, 2 patients in the step-down group treated with a high dose of BDP and no patients in the step-down group with oral steroids during first 4 weeks dropped out because of severe exacerbation of asthma. Although asthma symptoms and respiratory function significantly improved 8 weeks after the therapy in all groups, more significant and prompt improvements of these parameters were observed in patients of the step-down group than in patients of the step-up group after the first 2 weeks of treatment. Furthermore, step-down therapy with short-term oral steroid resulted in the lowest maintenance doses of BDP at 8 months of the three groups.


CONCLUSIONS
These results suggest that step-down therapy starting with a high dose of inhaled steroid and short-term oral steroid is more effective in gaining prompt control of asthma and reducing the severe exacerbation of asthma and the maintenance dose of inhaled steroids than a step-up therapy starting with a low dose of inhaled steroids in patients with moderate persistent asthma.
Adachi
M
M
First Department of Internal Medicine, Showa University, Tokyo, Japan.
Kohno
Y
Y
Minoguchi
K
K
D000280:Administration, Inhalation; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D001507:Beclomethasone / Q000008:administration & dosage*; D003888:Desensitization, Immunologic; D005541:Forced Expiratory Volume; D006801:Humans; D010366:Peak Expiratory Flow Rate; D011657:Pulmonary Eosinophilia / Q000276:immunology; D013183:Sputum / Q000166:cytology
D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D001507:Beclomethasone