How is it recommended to initiate therapy with inhaled steroids?
Currently, it is recommended to initiate therapy with inhaled steroids as early as possible in patients with persistent symptoms. Studies have shown that the longer one delays the institution of inhaled steroids in asthma, the less the quantum of benefit. When starting inhaled steroids, current opinion seems to favour starting with moderate-to-high doses. This has two advantages: • It enables rapid control of airway inflammation, thus getting the underlying disease under control. • It improves the confidence of the patient in his treatment, which subsequently improves compliance. Once treatment is initiated with a particular dose (e.g. 800 mcg of budesonide), that dose needs to be maintained for at least 3 months. Thereafter, a gradual reduction (approximately 25-50%) every month) may be done by monitoring symptoms and peak flow rates.
