SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

9/22/04

Comparative effects of triamcinolone, nedocromil on childhood asthma

Summary
Background - Treatment with inhaled corticosteroids (ICS) is being recommended increasingly for persistent asthma (PA) in children as well as in adults. However, inhaled nedocromil (Ned) or oral montelukast (Mont), a leukotriene receptor antagonist, are listed as possible alternative treatments in some practice guidelines. But what is the comparative efficacy of these therapeutic approaches?

Findings - Stelmach et al of the M. Curie Hospital in Zgierz, Poland carried out a randomized, non-blinded comparison of: a) inhaled triamcinolone (Triam), 400 microg/day; b) inhaled Ned; or c) oral Mont each given as monotherapy for 4 weeks in 256 children, ages 6-18 years with mild-moderate asthma. There was no placebo treatment component in this study. Following treatment with either Triam or Mont, the FEV-1 increased and mean total symptoms score, bronchial reactivity to inhaled histamine and blood eosinophil counts decreased significantly. The Triam effects were stronger than Mont in this regard. Both these treatments had significantly better effects on asthma symptomatology than did Ned therapy (p<0.01), particularly in reduction of nocturnal symptoms (p<0.001). There was reduced rescue use of inhaled beta agonists following treatment with the 3 drugs, most impressively following Triam therapy.

Reference
Pediatr Allergy Immunology 2004;15:359-64

Editor's Comments
The conclusions in this study are seriously limited by the absence of a placebo treatment control group, particularly considering the known spontaneous variability of asthma symptoms over a period of time. However, this study does have a strong attribute in its large study sample. The findings are not too surprising in face of other recent findings when inhaled corticosteroid treatment is compared with therapy with Ned or Mont.

 

<-- BACK