TABLE 6

Relationship between inhaled corticosteroid (ICS) use, step-up/step-down protocol and exacerbations

First author [ref.]Management planSeverity of populationTreatmentAtopicExacerbationICS use
AnyMajorMinor
Smith [24]FeNO + symptom-based safety protocolExcluded severeICSNRNS decreaseNS decreaseNS decreaseSS decrease
Shaw [25]FeNO + symptomsRecent severe exacerbations excludedICS, LTRA, bronchodilator66%NRNS decreaseNRSS decrease
Syk [14]FeNO onlyMild to moderateICS, LTRA100%SS decreaseNS increaseNS decrease (moderate)No change
Calhoun [13]FeNO onlyMild to moderateICS86%No changeNo changeNRNo change
Honkoop [16]FeNO + symptomsExcluded those taking OCS every day/every other dayICS, SABA, LABA, LTRA, OCS54%NRNS decreaseNRNR
  • FeNO: fractional exhaled nitric oxide; NR: not reported; NS: nonsignificant; SS: statistically significant; LTRA: leukotriene receptor antagonist; OCS: oral corticosteroid; SABA: short-acting β2-agonist; LABA: long-acting β2-agonist.