Background. Bronchial asthma exacerbations are frightening for individuals and are periodically deadly. We evaluated the principle that a plan for patients to handle their bronchial asthma (self-management strategy), which included a momentary quadrupling of the dose of inhaled glucocorticoids when bronchial asthma control started to wear away, would reduce the occurrence of severe bronchial asthma exacerbations among adults and teenagers with bronchial asthma.
Techniques
We conducted a pragmatic, unblinded, randomized test including grownups as well as teenagers with bronchial asthma that were receiving breathed in glucocorticoids, with or without add-on treatment, and also that had actually contended least one exacerbation in the previous 12 months.
We compared a self-management plan that consisted of a rise in the dosage of breathed in glucocorticoids by a factor of 4 (quadrupling team) with the very same strategy without such a boost (non-quadrupling team), over a period of 12 months. The key end result was the moment to a very first extreme asthma worsening, defined as therapy with systemic glucocorticoids or an unscheduled healthcare assessment for asthma.
Outcomes
An overall of 1922 participants went through randomization, of whom 1871 were included in the key analysis. The variety of participants who had an extreme asthma exacerbation in the year after randomization was 420 (45%) in the quadrupling team as compared to 484 (52%) in the non-quadrupling team, with a modified threat ratio for the time to a first severe exacerbation of 0.81 (95% confidence interval, 0.71 to 0.92; P=0.002).
The rate of damaging effects, which were related largely to neighborhood impacts of inhaled glucocorticoids, was higher in the quadrupling group than in the non-quadrupling team.
Conclusions
In this test involving grownups as well as teenagers with bronchial asthma, a personalized self-management plan that consisted of a momentary quadrupling of the dosage of breathed in glucocorticoids when asthma control started to degrade led to fewer serious asthma exacerbations than a plan in which the dosage was not boosted.
Funded by the Health Technology Assessment Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN15441965.