In reply. Data presented by Dr Williams support our recent observation that low-dose inhaled corticosteroids are effective in preventing ED visits for asthma.1 Although neither Dr Williams' study nor ours evaluated lung function or patient symptoms, a recently conducted meta-analysis from Holt and colleagues2 indicates that 80% of maximum benefits on lung function and symptoms occur at fluticasone-equivalent doses of 200 µg/d or less.2 Doses greater than 500 µg/d do not appear to add any additional therapeutic benefit for patients.2 On the other hand, risks of important systemic adverse effects including bone demineralization and cataracts increase in a dose-dependent fashion.3,4 For these reasons, we agree with the NAEPP guidelines suggesting that clinicians use the "lowest possible dose of inhaled corticosteroid to maintain control" of asthma.5 Based on current evidence, for most patients, this can be achieved with total daily doses less than 500 µg of fluticasone (or equivalent).
Sin DD, Man SFP. Potency of Inhaled Corticosteroid Fails to Predict Reduced Emergency Department Visits—Reply. Arch Intern Med. 2003;163(2):248-249. doi:10.1001/archinte.163.2.247-a