Temporarily quadrupling the dose of inhaled steroid to prevent asthma exacerbations: FAST

McKeever, Tricia; Mortimer, Kevin; Bradshaw, Lucy; Haydock, Rebecca; Pavord, Ian; Higgins, Bernard; Walker, Samantha; Wilson, Andrew; Price, David; Thomas, Mike; Devereux, Graham; Brightling, Christopher; Renwick, Charlotte; Parrott, Steve; Mitchell, Eleanor; Duley, Lelia; Harrison, Tim

doi:10.3310/hta22700

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An asthma self-management plan that advised patients to temporarily quadruple their dose of inhaled corticosteroid reduced asthma exacerbations, with fewer serious adverse events and at lower cost.

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Tricia McKeever ¹, Kevin Mortimer ², Lucy Bradshaw ³, Rebecca Haydock ³, Ian Pavord ⁴, Bernard Higgins ⁵, Samantha Walker ⁶, Andrew Wilson ⁷, David Price ^8,⁹, Mike Thomas ¹⁰, Graham Devereux ⁸, Christopher Brightling ⁷, Charlotte Renwick ¹¹, Steve Parrott ¹¹, Eleanor Mitchell ³, Lelia Duley ³, Tim Harrison ^1,^*

¹ Respiratory Medicine, Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
² Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, UK
³ Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
⁴ Respiratory Medicine Unit and Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
⁵ Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
⁶ Asthma UK, London, UK
⁷ University of Leicester, Leicester, UK
⁸ University of Aberdeen, Aberdeen, UK
⁹ Observational and Pragmatic Research Institute, , Singapore
¹⁰ University of Southampton, Southampton, UK
¹¹ University of York, York, UK
^* Corresponding author Email: tim.harrison@nottingham.ac.uk

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Response by Professor Tim Harrison on 1 February 2019 at 1:14 PM
Author response to reader question
Thanks for the question. If patients are on SMART or MART they should not be advised to quadruple their dose because the additional puffs of ICS/LABA taken instead of SABA automatically increases their dose of inhaled steroid and LABA when their symptoms increase. This is the reason patients on SMART or MART were excluded from the study

Response by Mrs Joy Chand on 15 January 2019 at 9:29 AM
quadrupling combined inhalers
If medication is quadrupled and the patient is on a SMART or MART system, could they quadrulple their combined inhalers or would they need to attend surgery to obtain a steroid only inhaler, not sure quadrupleing formetarol would be good?

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