Lewis J. Smith, M.D. N Engl J Med 2010; 363:1764-1765October 28, 2010
Current guidelines for treating patients with asthma whose symptoms are not controlled by a low dose of an inhaled glucocorticoid alone recommend either doubling the glucocorticoid dose or adding a long-acting beta-agonist (LABA).1 However, inhaled glucocorticoids have a relatively flat dose–response curve, so doubling the dose may result in little or no improvement in individual patients.2
LABAs are generally more effective,1 , 3 but an increased concern about infrequent but life-threatening exacerbations4 has reduced enthusiasm for the use of these drugs. Alternatives to the addition of LABA therapy include high doses of inhaled glucocorticoids, leukotriene modifiers, theophylline, anti-IgE therapy for selected . . .
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