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Am Fam Physician. 2023;108(2):137-138

Author disclosure: No relevant financial relationships.

Clinical Question

Does patient-initiated home management of asthma exacerbations with increased doses of inhaled corticosteroids (ICSs) reduce the need for further intervention compared with a daily maintenance dosage of an ICS among children and adults with mild to moderate persistent asthma?

Evidence-Based Answer

In this Cochrane review, patients with mild to moderate persistent asthma and symptoms consistent with an acute asthma exacerbation who are treated with increased doses of ICSs show no reduction in the need for further intervention with primarily systemic corticosteroids vs. patients treated with stable doses of ICSs. Similarly, increased doses of ICSs do not reduce unscheduled visits to physicians, acute care facilities, or emergency departments or hospital admissions compared with stable doses of ICSs.1 (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Asthma is a leading cause of morbidity and mortality related to chronic respiratory disease; it affects 272 million people worldwide.2,3 Early recognition and management of asthma exacerbations are essential in reducing morbidity, mortality, and health care costs associated with asthma. Asthma action plans, which are written, patient-initiated, home management guidelines that describe maintenance therapy and steps for treatment escalation during an exacerbation, decrease the severity and duration of asthma exacerbations.1 ICSs are a mainstay of asthma action plans, and the Global Initiative for Asthma (GINA) guideline recommends increased ICS dosing during an asthma exacerbation.4

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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