Child using inhaler for asthma management.

Inhaled Steroids for Kids' Asthma: Are Higher Doses Always Better?

Mira Elwood in Health & Wellness August 2025 • 4 min read.

"Debunking the Myth: Research shows increasing inhaled steroid doses during asthma flare-ups doesn't necessarily reduce the need for systemic steroids in children."

Asthma, a chronic respiratory condition, affects a significant number of children, impacting their quality of life and placing a burden on families and healthcare systems. Effective management of asthma is crucial, and inhaled corticosteroids (ICS) play a vital role in controlling symptoms and preventing flare-ups.

When children experience asthma flare-ups, parents and healthcare providers often consider increasing the dose of ICS to quickly alleviate symptoms and prevent the need for oral steroids, which can have undesirable side effects. But is this approach always the most effective?

Recent research, including a Cochrane review analyzing data from multiple pediatric studies, challenges the assumption that higher doses of ICS during flare-ups are more beneficial. This article explores the findings of this review and what they mean for managing asthma in children.

The Great Inhaled Steroid Debate: What the Research Reveals

Child using inhaler for asthma management.

A comprehensive Cochrane review examined the effectiveness of increasing ICS doses versus maintaining stable doses in children experiencing asthma flare-ups. The analysis focused on whether increasing ICS reduced the need for systemic corticosteroids (oral steroids) to control the flare-up.

Surprisingly, the review of three pediatric studies (involving 358 children) revealed that increasing inhaled steroids during flare-ups did not significantly reduce the need for systemic corticosteroids compared to children who remained on their maintenance dose.

No Significant Difference: Children who increased their inhaled steroid dose were just as likely to require systemic corticosteroids as those who stuck to their regular maintenance dose (Odds Ratio 0.93, 95% CI 0.61-1.41).
Limited Data on Other Outcomes: The review found insufficient evidence to determine if increased ICS doses affected rates of unscheduled doctor visits, emergency room visits, or hospital admissions.
Study Details: The included studies compared increased ICS doses to maintenance doses at the onset of asthma flare-ups, within the context of a patient-initiated asthma action plan. The primary outcome was the subsequent need for systemic corticosteroids.

These findings suggest that simply increasing the dose of inhaled steroids at the first sign of a flare-up may not be the most effective strategy for all children. It's important to note that all study participants were already on maintenance ICS therapy, and the studies focused on managing acute flare-ups at home.

Rethinking Asthma Flare-Up Management: A More Holistic Approach

The research highlights the need for a more nuanced approach to managing asthma flare-ups in children. Instead of solely relying on increased ICS doses, a comprehensive strategy should be implemented, guided by a healthcare professional.

This strategy should include regular monitoring of symptoms, trigger identification and avoidance, optimization of baseline ICS therapy, and a well-defined asthma action plan that outlines when and how to use rescue medications like short-acting beta-agonists. It also suggests that a stepwise approach should be considered, where other therapies like oral steroids are introduced in certain cases.

While increased ICS might be appropriate in some cases, it shouldn't be the default response for every flare-up. Parents and caregivers should work closely with their child's doctor to develop a personalized asthma management plan that addresses the individual needs and triggers of the child, and ensures the judicious use of oral corticosteroids to prevent any adverse effects.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/jpc.13680, Alternate LINK

Title: Increased Doses Of Inhaled Corticosteroids During Home Management Of Asthma Flare-Ups Do Not Reduce The Need For Systemic Steroids

Subject: Pediatrics, Perinatology and Child Health

Journal: Journal of Paediatrics and Child Health

Publisher: Wiley

Authors: Bernadette Prentice, Nusrat Homaira, Adam Jaffé

Published: 2017-09-01

Everything You Need To Know

Does increasing inhaled steroid dosage help kids during an asthma flare-up?

Recent research, specifically a Cochrane review, indicates that increasing the dose of inhaled corticosteroids during asthma flare-ups in children may not significantly decrease the need for systemic corticosteroids like oral steroids. The review found that children who increased their inhaled steroid dose were just as likely to require systemic corticosteroids as those who stayed on their maintenance dose.

Besides reducing the need for oral steroids, what other benefits were observed when increasing inhaled corticosteroid dosage during flare-ups?

The Cochrane review examined the impact of increased doses of inhaled corticosteroids on various outcomes. However, there was limited data to determine if increased inhaled corticosteroid doses affected rates of unscheduled doctor visits, emergency room visits, or hospital admissions. The primary focus was the need for systemic corticosteroids when inhaled steroid doses were increased at the onset of asthma flare-ups.

Are the findings applicable to all children with asthma, including those not already on inhaled corticosteroids?

The studies included in the Cochrane review focused on children already using maintenance inhaled corticosteroids who experienced asthma flare-ups. These studies compared increased inhaled corticosteroid doses to maintenance doses within the context of patient-initiated asthma action plans. This means the findings are most applicable to managing acute flare-ups at home in children already receiving regular treatment.

If simply increasing the dose of inhaled steroids isn't always the answer during a flare-up, what else should be done?

Instead of solely increasing the dose of inhaled corticosteroids during a flare-up, a more comprehensive strategy is recommended. This approach should be guided by a healthcare professional and may include optimizing maintenance therapy, identifying and avoiding triggers, using proper inhaler techniques, and considering other medications. Regular monitoring and adjustments to the asthma action plan are also crucial.

Does this mean inhaled corticosteroids are not important for managing asthma in children?

While the research suggests that simply increasing inhaled corticosteroid doses may not always be the most effective strategy, inhaled corticosteroids remain a vital component of asthma management. They help control inflammation in the airways, reducing the frequency and severity of flare-ups. The key is to use them appropriately as part of an individualized asthma action plan developed with a healthcare provider, rather than relying solely on dose increases during acute episodes.