Researchers from the University Hospitals Cleveland Medical Center have reported that escalating inhaled steroid dosages from the normal dose early in an asthma flare-up failed to prevent exacerbations or minimize severity in children with mild-to-moderate persistent asthma.

For one year, researchers measured benefits of quintupling inhaled steroid doses during the earliest signs of an asthma attack. This period — known as the "yellow zone" — is when wheezing, coughing, and shortness of breath first appear.

"Increasing the dose of inhaled steroids at early signs of asthma worsening along with using quick-relief medicines to relieve symptoms is a common practice," says study author Kristie Ross, assistant professor of pediatrics at Case Western Reserve University School of Medicine.

"Our study shows that this is no more effective at preventing progression to more serious asthma exacerbations than the use of quick-relief medicines alone, such as albuterol inhalers," Ross adds.

All 254 children in the randomized, double-blinded study used low dose controller inhalers — "two puffs twice daily" –for a standard maintenance dose of inhaled steroid medication. When parents noticed their child had yellow zone symptoms, the researchers instructed them to use a different inhaler for seven days.

Half of the inhalers were the same low dose, and the other half contained five times the maintenance dose. The researchers did not find any significant difference in the number of asthma attacks that ultimately required systemic steroids. Despite a 16% increase in exposure to inhaled steroids, children in the high-dose group did not experience fewer attacks.

The researchers did find children in the high-dose group had slower growth rates — averaging 0.23 centimeters per year less than children who maintained the low-dose regimen. Children with over two yellow zone episodes in a year, and children aged 5-7 were most affected.

The study focused on preventing early, mild asthma symptoms from progressing to dangerous attacks. Parents should continue to work with their child's asthma doctor to develop a personalized home management plan that includes yellow zone interventions, she says.

"Our study suggests we need to find better ways to identify early signs of asthma worsening that are likely to lead to more serious asthma exacerbations," Ross says. "We will be starting a study this summer on a way to do that using technology that collects information about the child and the environment with less burden on the family, that may help us better predict asthma flares."