What Color is Your Yellow Zone? Is There a Role for Escalation of Anti-inflammatory Therapy Short of an Oral Corticosteroid Burst?

Abstract

ABSTRACT Current asthma management guidelines advise management of mild asthma exacerbations with short-acting beta agonists, followed by consideration of a short course of systemic corticosteroids. Problems with this approach include lack of effect of beta agonists on flareup progression, and the toxicity of systemic corticosteroids. There is a need for a management strategy for mild exacerbations intermediate between beta agonist only and addition of systemic corticosteroids. Randomized controlled clinical trials on doubling doses of inhaled corticosteroid AFTER an asthma exacerbation is established have shown no benefit; however, this strategy may be too little, too late. Other randomized controlled clinical trials have examined either escalation from low- to high-dose inhaled corticosteroid (quadrupling dose) or escalation of the inhaled corticosteroid concurrently with the beta agonist in an inhaler that combines both medications (i.e., one combination inhaled steroid + rapid acting beta agonist inha...