Charity calls for review of oral steroids for asthma

Asthma treatment with oral steroids in UK general practice should be studied to ensure systemic treatment is not being underused, according to Asthma UK's chief medical officer.

The suggestion follows the publication of a paper arguing that oral steroids should be prescribed for all but the mildest asthma exacerbations.

Dr Steven Doherty of Australia's University of Newcastle wrote that, unless contraindications are present, patients with acute asthma should receive systemic corticosteroid doses equivalent to 1 mg/kg a day of prednisolone.

Dr Doherty examined evidence on the treatment of asthma exacerbations in emergency departments. He found that systemic corticosteroids were underprescribed.

'Although inhaled corticosteroids may yet be proved to be as effective as oral corticosteroids, most evidence to date favours systemic corticosteroids both in the acute stage and after discharge,' he said.

Dr Mike Thomas, chief medical officer for Asthma UK and a GP in Minchinhampton, Gloucestershire, said use of oral steroids by GPs and in A&E should be investigated.

He told GP that a short course of oral steroids was a safe and effective treatment for acute asthma exacerbations.

'Not every patient seen by GPs with a worsening of their asthma automatically needs a course of steroids, although if this is indeed a true asthma exacerbation then oral steroids should be given,' he said.

British Thoracic Society guidelines state that the old advice to 'double the dose or (give) oral steroids' is ineffective, and oral steroids should usually be given in the event of an exacerbation, he added.

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