COMPARISON OF SHORT COURSES OF ORAL PREDNISOLONE AND FLUTICASONE PROPIONATE IN THE TREATMENT OF ADULTS WITH ACUTE EXACERBATIONS OF ASTHMA IN PRIMARY-CARE

Background - Oral corticosteroids used in short courses for acute asth ma are regarded as safe, although the frequent use of these drugs may result in patients suffering from systemic side effects. It has become common practice for patients to increase their own inhaled corticoste roid intake when their asthma goes out of control, but it has never be en established whether a high dose of inhaled corticosteroid can be as effective as a short course of oral corticosteroid in the treatment o f acute exacerbations. Methods - A multicentre, randomised, double bli nd, double dummy, parallel group study was undertaken to determine whe ther the introduction of a high dose of inhaled fluticasone propionate (2 mg daily) is as effective as a short reducing course of oral predn isolone (starting at 40 mg/day and reducing by 5 mg every other day) i n the treatment of acute exacerbations of asthma not considered severe enough for admission to hospital but requiring treatment with oral co rticosteroid. Results - Four hundred and thirteen adult asthmatic subj ects who presented to their general practitioner with an acute exacerb ation of asthma were recruited in 47 general practices in the United K ingdom. Treatment failures, defined as a reduction in peak expiratory flow (PEF) to below 60% of the patient's best/predicted value on two c onsecutive occasions or persistent symptoms with no improvement on thr ee consecutive days, occurred in 23% of patients who received oral pre dnisolone and 27% who received inhaled fluticasone propionate (differe nce in percentage of treatment failures 4.3, 95% CI -4.1 to 12.8, p = 0.31). In each group 48% were classified as treatment successes, defin ed as a 10% or greater increase in percentage best/predicted morning P EF. Both treatments were equally well tolerated. Conclusions - There i s no evidence of a significant difference in efficacy between a reduci ng dose course of oral prednisolone and high dose inhaled fluticasone propionate in mild exacerbations of asthma which do not require admiss ion to hospital.