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Editorials: Point and Counterpoint |

POINT: Is Escalation of the Inhaled Corticosteroid Dose Appropriate for Acute Loss of Asthma Control in an Attempt to Reduce Need for Oral Corticosteroids in Children? Yes

Harold J. Farber, MD, MSPH, FCCP
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST the following: H. J. F. serves as Associate Medical Director for Texas Children’s Health Plan, a not-for-profit Medicaid and CHIP managed care organization owned by Texas Children’s Hospital.

Pulmonary Section, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX

CORRESPONDENCE TO: Harold J. Farber, MD, MSPH, FCCP, Texas Children’s Hospital, Pulmonary Medicine Service, 6701 Fannin, Ste 1040.00, Houston, TX 77030


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):488-490. doi:10.1016/j.chest.2016.06.024
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Extract

Guidelines from the National Asthma Education and Prevention Program (2007) recommend managing mild asthma exacerbations with the addition of a short-acting beta agonist to the treatment regimen, and if response is incomplete, adding an oral corticosteroid. Escalating the dose of long-acting controller medication is not recommended as part of management of the acute exacerbation. This approach has several significant problems:

  • Oral corticosteroid medications, although effective, have significant toxicity, even in short bursts.

  • The use of beta agonists relieves asthma symptoms but does not prevent a mild exacerbation from progressing to a severe exacerbation.

  • Nonadherence to the daily use of long-acting controller medication is extremely common.,

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