Dose response of inhaled corticosteroids on bronchial hyperresponsiveness: a meta-analysis

Ann Allergy Asthma Immunol. 2003 Feb;90(2):194-8. doi: 10.1016/S1081-1206(10)62140-0.


Background: There is a relatively steep dose-response curve for effects of inhaled corticosteroids on conventional airway markers of asthmatic disease control.

Objective: We sought to determine whether a dose-response effect exists for bronchial hyperresponsiveness.

Methods: A meta-analysis of placebo-controlled trials in asthmatic patients was performed using a computerized systematic review of databases. Doubling dose/dilution protection of inhaled corticosteroid was compared with placebo. Studies which used direct (methacholine and histamine) and indirect (adenosine monophosphate) bronchial challenge stimuli were eligible for inclusion.

Results: Twenty-five studies fulfilled eligibility criteria (963 patients). Values for doubling dose/dilution protection categorized by low/medium dose (< 1,000 microg) and high dose (> or = 1,000 microg) of inhaled corticosteroid amounted to a 1.25 (95% confidence interval 1.08 to 1.42) and 2.16 (95% confidence interval 1.88 to 2.44) shift, respectively.

Conclusions: High doses of inhaled corticosteroids conferred greater improvements in bronchial hyperresponsiveness than low doses.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Administration, Inhalation
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / therapeutic use*
  • Anti-Inflammatory Agents / administration & dosage*
  • Anti-Inflammatory Agents / therapeutic use*
  • Asthma / drug therapy*
  • Bronchial Hyperreactivity / drug therapy
  • Bronchial Hyperreactivity / physiopathology*
  • Bronchial Provocation Tests
  • Bronchoconstrictor Agents
  • Dose-Response Relationship, Drug
  • Humans
  • Randomized Controlled Trials as Topic / methods
  • Steroids
  • Treatment Outcome


  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents
  • Bronchoconstrictor Agents
  • Steroids