Evidence map›Paper›PMID 30645143›Full record

ReviewAmerican journal of respiratory and critical care medicine2019

Inhaled Corticosteroid Therapy in Adult Asthma. Time for a New Therapeutic Dose Terminology.

Richard Beasley, James Harper, Grace Bird, Ingrid Maijers, Mark Weatherall, Ian D Pavord

Registry-linked trialAbstract readReview
PubMed Publisher
In one paragraph

Review in American journal of respiratory and critical care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07224061 (Promoting Asthma Guidelines and Management Through Technology-Based Intervention and Care Coordination in Clinics and Schools), which is not on this map. Cited by 70 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
70citing papers in PubMed, 4 pooled it
8.1field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07224061 narecruitingnot on this mapstarted 2026, after this paper: background citation

Promoting Asthma Guidelines and Management Through Technology-Based Intervention and Care Coordination in Clinics and Schools (PRAGMATIC-S)

TypeinterventionalSponsorMontefiore Medical CenterRan2026 to 2033Enrolled420ConditionsAsthma in ChildrenArmsPRAGMATIC-S
3 · Its place in the literature

Who cites it

70 citing papers in PubMed, 4 syntheses or guidelines pooled it, 142 citations in OpenAlex.

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  14. Phenotyping treatment-naive uncontrolled asthma in adults: A primary care framework.The journal of allergy and clinical immunology. Global · 2026
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10 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 2 countries.

Richard Beasley1 Medical Research Institute of New Zealand, Wellington, New Zealand.ORCID 0000-0003-0337-406X
James Harper1 Medical Research Institute of New Zealand, Wellington, New Zealand.ORCID 0000-0002-6416-1466
Grace Bird1 Medical Research Institute of New Zealand, Wellington, New Zealand.ORCID 0000-0002-3761-2778
Ingrid Maijers1 Medical Research Institute of New Zealand, Wellington, New Zealand.ORCID 0000-0002-4688-4927
Mark Weatherall3 Capital & Coast District Health Board, Wellington, New Zealand.ORCID 0000-0002-0051-9107
Ian D Pavord5 Oxford Respiratory, National Institute for Health Research Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.ORCID 0000-0002-4288-5973
Medical Research Institute of New Zealand · NZCapital and Coast District Health Board · NZNational Institute for Health Research · GBVictoria University of Wellington · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The Global Initiative for Asthma guidelines use the traditional terminology of "low," "medium," and "high" doses of inhaled corticosteroids (ICS) to define daily maintenance doses of 100 to 250 μg, >250 to 500 μg, and >500 μg, respectively, of fluticasone propionate or equivalent for adults with asthma. This concise clinical review proposes that this terminology is not evidence based and that prescribing practice based on this terminology may lead to the use of inappropriately excessive doses of ICS. Specifically, the ICS dose that achieves 80-90% of the maximum obtainable benefit is currently classified as a low dose, with the description of two higher dose levels of medium and high, which are associated with significant risk of systemic adverse effects. Asthma guidelines and clinician prescribing practice need to be modified in accordance with the currently available evidence of the dose-response relationship of ICS in adult asthma. We propose a reclassification of ICS doses based on a "standard daily dose," which is defined as 200-250 μg of fluticasone propionate or equivalent, representing the dose at which approximately 80-90% of the maximum achievable therapeutic benefit of ICS is obtained in adult asthma across the spectrum of severity. It is recommended that ICS treatment be started at these standard doses, which then represent the doses at which maintenance ICS are prescribed at step 2 and within ICS/long-acting β-agonist combination therapy at step 3. The opportunity is available to prescribe higher doses within ICS/long-acting β-agonist maintenance therapy in accordance with the stepwise approach to asthma treatment at step 4.

Indexed as

Dose-Response Relationship, DrugAdministration, InhalationAdrenal Cortex HormonesAdultAgedAged, 80 and overAnti-Asthmatic AgentsAsthmaFemaleFluticasoneHumansMaleMiddle AgedPractice Guidelines as TopicAdrenal Cortex HormonesAnti-Asthmatic AgentsFluticasoneasthmadose–response relationshipinhaled corticosteroids

Identifiers

PMID30645143
OpenAlexW2909000245

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.