From the Guidelines
The recommended corticosteroid dose for treating airway inflammation is typically inhaled corticosteroids as first-line treatment, with the option to step-up the dose if response is incomplete.
Key Considerations
- In adult and adolescent patients with chronic cough due to asthma, inhaled corticosteroids should be considered as first-line treatment 1.
- If response is incomplete, stepping-up the inhaled corticosteroid dose and considering a therapeutic trial of a leukotriene inhibitor may be necessary 1.
- For patients with non-asthmatic eosinophilic bronchitis (NAEB), inhaled corticosteroids are also suggested as first-choice treatment 1.
- A trial of oral corticosteroids, such as prednisolone 30 mg/day for 2 weeks, may be used to assess responsiveness to corticosteroids in patients with chronic cough 1.
Important Details
- The evidence base supporting the step-wise treatment for asthma is very strong, but cough-specific studies in asthma are limited 1.
- The presence of eosinophilic airway inflammation is likely to be associated with a more favorable response to corticosteroids 1.
- Alternative diagnoses should be considered in patients with apparently corticosteroid-resistant cough variant asthma 1.
From the Research
Recommended Corticosteroid Dose
The recommended corticosteroid dose for treating airway inflammation is not explicitly stated in the provided studies. However, the studies suggest that:
- Inhaled corticosteroids are effective in reducing airway inflammation and improving symptoms in patients with asthma and chronic obstructive pulmonary disease (COPD) 2, 3, 4.
- High doses of inhaled corticosteroids, such as fluticasone propionate, can reduce airway inflammation and improve symptoms in patients with mild-to-moderate asthma 3.
- The dose-response effect of inhaled corticosteroids on airway inflammation suggests that higher doses may be more effective in reducing inflammation, but may also increase the risk of adverse effects 3.
Key Findings
- Inhaled corticosteroids can reduce airway inflammation, improve lung function, and prevent exacerbations in patients with asthma and COPD 2, 3, 4.
- Systemic corticosteroids can have significant side effects, especially with long-term use, and should be used cautiously in the treatment of upper airway diseases 5.
- Novel anti-inflammatory therapies, such as omalizumab, are being developed to target specific aspects of airway inflammation in patients with asthma 6.
Treatment Considerations
- Inhaled corticosteroids should be considered as first-line therapy for chronic asthma, with the aim of suppressing inflammation and reducing the need for bronchodilator therapy 4.
- The choice of corticosteroid dose and treatment regimen should be individualized based on the patient's disease severity, response to treatment, and risk of adverse effects 2, 3, 6.