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British Guideline on the MAnAGeMent of AsthMA
4.2.2 INHALED STEROIDS
40
Inhaled steroids are the most effective preventer drug for adults and older children for achieving
overall treatment goals. 278-282 There is an increasing body of evidence demonstrating that,
at recommended doses, they are also safe and effective in children under five years with
asthma. 283-286,847-854
Many non-atopic children with recurrent episodes of viral-induced wheezing in children under
five years do not go on to have chronic atopic asthma. The majority do not require treatment
with regular inhaled steroids (see section 2.1).
A A A inhaled steroids are the recommended preventer drug for adults and children
for achieving overall treatment goals.
Inhaled steroids should be considered for adults, children aged 5-12 and children under the age
of five with any of the following features: using inhaled β 2 agonists three times a week or more;
symptomatic three times a week or more; or waking one night a week. In addition, inhaled
steroids should be considered in adults and children aged 5-12 who have had an exacerbation
287,288 ,767-769
of asthma requiring oral corticosteroids in the last two years.
inhaled steroids should be considered for patients with any of the following asthma-related
features:
B C exacerbations of asthma in the last two years
B B B using inhaled β 2 agonists three times a week or more
B B B symptomatic three times a week or more
B C ; waking one night a week.
Starting dose of inhaled steroids
In mild to moderate asthma, starting at very high doses of inhaled steroids and stepping down
confers no benefit. 289
; Start patients at a dose of inhaled steroids appropriate to the severity of disease.
; In adults, a reasonable starting dose will usually be 400 micrograms BDP per day and in children
200 micrograms BDP per day. In children under five years, higher doses may be required if
there are problems in obtaining consistent drug delivery.
; Titrate the dose of inhaled steroid to the lowest dose at which effective control of asthma
is maintained.
Frequency of dosing of inhaled steroids
Most current inhaled steroids are slightly more effective when taken twice rather than once
daily, but may be used once daily in some patients with milder disease and good or complete
273, 279,290, 767, 770
control of their asthma.
There is little evidence of benefit for dosage frequency more than twice daily. 279
A A A Give inhaled steroids initially twice daily, except ciclesonide which is given
once daily.
A A A once a day inhaled steroids at the same total daily dose can be
considered if good control is established.
>12
years
5-12
years
12
years
5-12
years
12
years
>12
years
5-12
years
1 + 1 +
5-12
years