High-dose steroids don’t prevent asthma flare-ups

Professor Phil Bardin

High-doses of glucocorticoids are not effective in preventing life-threatening asthma exacerbations, according to a landmark study published in The New England Journal of Medicine last week.

Monash University’s Professor Phil Bardin was specially invited by the NEJM to assess the evidence for this therapy based on two recent asthma clinical trials.

“Inhaled glucocorticoids are pivotal to achieve asthma control in both children and adults but despite their use, many patients with asthma have flare-ups,” said Professor Bardin, Director Monash Lung & Sleep.

“Acute flares of asthma are detrimental because they adversely affect quality of life, lung function, and health care costs and have the potential to end in death.”

“Everyone agrees that preventing exacerbations is a priority in asthma care,” Professor Bardin said.

Professor Bardin said asthma specialists have long thought that more aggressive use of inhaled glucocorticoids can prevent exacerbations if initiated at the first signs of deterioration.

Professor Bardin found good evidence that children, in particular, receive no significant benefit from high-dose inhaled glucocorticoids in terms of their likelihood of having an asthma attack.

“The evidence indicates that substantial escalation of regularly used inhaled glucocorticoids, even by a factor of 4 or 5, fails to prevent most asthma exacerbations,” Professor Bardin said.

The editorial invitation by the prestigious journal is due to Professor Bardin and his team’s significant research into asthma at the Monash Health Translation Precinct (MHTP).

“The invitation to contribute to the NEJM on this topic is a testament to our global reputation built upon the outstanding clinical research done at Monash over many years,” Professor Bardin said.

“In particular, the Clinical Trials Unit in Monash Lung and Sleep, Monash Health under the leadership of Ms Joanne McKenzie has recently conducted ground-breaking research on monoclonal antibodies in asthma.”

This new treatment has had dramatic benefits for many patients with crippling severe asthma.