Management of Inhaled Corticosteroids During Mild Respiratory Illness in Asthmatic Patients

Evidence-Based Recommendation

The National Asthma Education and Prevention Program (NAEPP) recommends that patients aged 4 years and older who are adherent to their daily inhaled corticosteroid (ICS) regimen should not increase their ICS dose during a mild respiratory illness, as this does not significantly reduce the rate of exacerbations or improve asthma quality of life 1, 3
The American Thoracic Society and other guideline societies support the recommendation that increasing the ICS dose in the setting of an exacerbation is not recommended for patients with mild to moderate persistent asthma who are likely to be adherent to daily ICS treatment, with a strength of evidence rated as moderate 2

Controlled clinical trials have shown that temporarily increasing the ICS dose in response to worsening symptoms does not significantly reduce the rate of exacerbations or improve asthma quality of life in children aged 4-11 years, with a low certainty of evidence 2
A study of 254 children found no difference in the rate of exacerbations treated with systemic corticosteroids when quintupling the ICS dose at early signs of loss of asthma control, and the intervention group showed a trend toward reduced growth rate (P=0.06), with a moderate quality of evidence 2

The National Asthma Education and Prevention Program (NAEPP) recommends that the working group recommendation not to increase ICS dose applies only to patients who are adherent to their maintenance ICS therapy, with a strength of evidence rated as high 1, 3
For patients aged 16 years and older whose adherence to daily therapy is not assured, clinicians can consider quadrupling the regular daily dose for increased symptoms or decreased peak flow, with a moderate quality of evidence 2

The American Academy of Allergy, Asthma, and Immunology recommends that patients should continue their current maintenance ICS regimen without dose adjustment during a mild respiratory illness, with a high strength of evidence 1, 2
Patients should use short-acting beta-agonist (SABA) as needed for symptom relief, with a moderate quality of evidence 4, 5
For patients on ICS-formoterol maintenance and reliever therapy (SMART), they should continue using as-needed ICS-formoterol for symptom relief, with a high strength of evidence 1, 3

The National Asthma Education and Preventionogle Program (NAEPP) recommends that oral corticosteroids should be considered if the patient experiences treatment failure despite appropriate use of maintenance ICS and rescue SABA, with a high strength of evidence 2
Oral corticosteroids should also be considered if there is evidence of a moderate to severe exacerbation requiring urgent medical attention, with a moderate quality of evidence 2