title: Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations.
abstract: BACKGROUND
  Previous guidelines recommend doubling the daily dose of maintenance inhaled corticosteroid to treat or prevent progression of exacerbations of asthma.
  
  
  METHODS
  Over a 6 month period a cohort of patients were evaluated prospectively and randomised in a double blind controlled trial to treatment with either a continued maintenance dose (MD) of inhaled corticosteroid or doubling the dose (DD) at the time of an exacerbation.
  
  
  RESULTS
  A total of 290 patients were randomised (33% male) and 98 (DD, n = 46) experienced evaluable asthma exacerbations during the study period. Mean (SD) baseline characteristics at randomisation (age 33.5 (14.0) years; forced expiratory volume in 1 second (FEV(1)) 2.8 (0.7) l; peak expiratory flow (PEF) 422.9 (110.5) l/min) were similar in both groups. In the DD group 41% of patients were considered treatment failures because they either required systemic steroids (n = 12), had an unscheduled visit to a physician (n = 1), or their asthma did not return to baseline (n = 6). This did not differ from the MD group in which 40% were treatment failures (n = 9, 0, and 12, respectively; p = 0.94).
  
  
  CONCLUSIONS
  In patients who regularly take an inhaled corticosteroid, doubling the maintenance dose may not affect the pattern of the exacerbation.
authors.affiliation: Respiratory Medicine, Center for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver General Hospital Research Pavilion, 822 West 10th Avenue, Vancouver, BC, Canada V5Z 1L8. markf@interchange.ubc.ca
authors.forename: J M
authors.initials: JM
authors.lastname: FitzGerald
authors.forename: A
authors.initials: A
authors.lastname: Becker
authors.forename: M R
authors.initials: MR
authors.lastname: Sears
authors.forename: S
authors.initials: S
authors.lastname: Mink
authors.forename: K
authors.initials: K
authors.lastname: Chung
authors.forename: J
authors.initials: J
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D019819:Budesonide