Large UK study finds that serious asthma attacks are reduced by the temporary quadrupling of a steroid inhaler

News article 8 Mar 2018

An LSTM-supported study published today in the New England Journal of Medicine has found that serious asthma attacks in adults can be reduced by temporarily quadrupling the dose of inhaled steroids when asthma control starts to be lost.


LSTM’s Dr Kevin Mortimer was the Principal Investigator for the trial in Liverpool which was led nationally by the University of Nottingham and involved over 1900 participants from across the UK. Previous work by the University had found that doubling the dose of inhaled steroids did not prevent the frequency of serious attacks which led to this new trial being funded by the National Institute for Health Research (NIHR) to see if quadrupling the dose would be beneficial.

Asthma is a common chronic disease and affects around 300 million people worldwide. Serious attacks can lead to hospitalisation, serious ill health and even death, with three deaths from asthma in the UK every day. According to the National Review of Asthma Deaths, two thirds of these deaths could be prevented with basic asthma care, which includes patients getting a written asthma action plan from their doctor, which outlines the medicine they should use.

The Fourfold Asthma Study (FAST) compared two asthma self-management plans in people with asthma over a 12-month period. The study found that participants in the quadrupling group had a 20% reduction in severe asthma attacks compared with the usual care group and they also had fewer asthma-related hospital admissions as only 3 patients in the quadrupling group were admitted to hospital compared with 18 in the usual care group.

Liverpool had one of the largest number of volunteers taking part in the trial. Dr Kevin Mortimer said: “This study is a great example of people coming together – patients with asthma, many NHS organisations and Universities and partners including Asthma UK – to deliver a major clinical trial. In Liverpool and surrounding areas, we had a very successful collaboration across a large number of NHS organisations with major contributions to the trial from Aintree University Hospital, the Royal Liverpool University Hospital and several Primary Care Trusts. The trial has provided a clear answer the question it set out to address and will hopefully lead to meaningful benefits for people with asthma in the UK and beyond. It’s worth remembering, however, that a large proportion of the 300 million people with asthma around the world lack access to basic effective inhaler treatments - let alone the ability to quadruple inhaled steroids in this way – and tackling this problem is a priority for us at LSTM”.

Tricia McKeever, Ph.D., Kevin Mortimer, Ph.D., Andrew Wilson, M.D., Samantha Walker, Ph.D., Christopher Brightling, Ph.D., Andrew Skeggs, B.Sc., Ian Pavord, F.Med.Sci., David Price, F.R.C.G.P., Lelia Duley, M.D., Mike Thomas, Ph.D., Lucy Bradshaw, M.Sc., Bernard Higgins, Ph.D., Rebecca Haydock, B.Sc., Eleanor Mitchell, B.A., Graham Devereux, Ph.D., and Timothy Harrison, M.D. Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations .  N Engl J Med 2018; 378:902-910 March 8, 2018 DOI: 10.1056/NEJMoa1714257