Is “Yellow Zone” Management Effective in Reducing Asthma Flares in Children?

Abstract

Current guidelines include the option (Class B evidence) of “yellow zone” management to increase the dose of inhaled corticosteroids (ICSs).1,2 This was developed from early observational studies indicating that this may reduce the risk of flares.3-5 However, randomized controlled trials and a systematic review found that this strategy was not effective.6-8 The reviewed study aimed to evaluate the efficacy and safety of increasing the ICS dose as a “yellow zone” management strategy in children.Methods This was a randomized, double-blind parallel group trial conducted in the United States. During “yellow zone” episodes, there was no difference in symptom scores (P = .30) or albuterol inhaler use (P = .30).Adverse effects The growth rate among the high-dose group (5.43 cm/y) was 0.23 cm/y less than the growth rate among the low-dose group (5.65 cm/y; 95% CI, −0.47 to 0.01; P = .06). Because not all “yellow zone” episodes progress to severe exacerbations, there may be a risk of bias in interpreting the results.