SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

12/15/06

Comparison of controller therapies in mild to moderate pediatric asthma

Summary
Background – More evidence is needed to base recommendations for the treatment of mild-moderate persistent asthma (PA) in children.

Findings – Sorkness et al of the Pediatric Asthma Controller Trial (PACT) compared the effectiveness of 3 regimens in controlling mild-moderate PA in children in a double blind treatment trial for 48 weeks.

They found that monotherapy with inhaled fluticasone (FP, an inhaled corticosteroid (ICS), 100 mcg twice daily, and a combination of FP 100 mcg/salmeterol 50 mcg in the morning and salmeterol 50 mcg in the evening both resulted in a higher frequency of asthma controlled days than did montelukast, a leukotriene receptor antagonist, 5 mg taken in the evening. However, FP monotherapy was significantly more effective than the combination FP/salmeterol regimen in: 1) improved FEV-1/FVC ratios; 2) maximum bronchodilator response to inhaled albuterol; 3) decreased levels of nitric oxide in exhaled air (a marker of bronchial inflammation); 4) decreased bronchial reactivity to inhaled methacholine.

There was no significant difference in the growth rates of these children over 4-8 weeks during the 3 treatment regimens.

Reference
J Allergy Clin Immunol 2006;Nov 29, E pub

Editor's Comments
These findings suggest that monotherapy with FP, 200 mcg/day is superior in several respects to combination FP/salmeterol treatment (with a 100 mcg/day dose of FP) in childhood PA of mild-moderate degree. As such, these findings differ from that in several previous studies of adults with moderate PA in which asthma control was at least as good during treatment with a combination of low dose FP plus salmeterol than seen during monotherapy with at least twice the dose of FP. Similar findings in adult asthmatics have been found using another ICS/LABA combination, budesonide and formoterol, compared with budesonide as monotherapy. The findings in this current study will help support the contention of those who advocate not using inhaled LABA as first-line therapy for PA because of a reported increased frequency of fatal/near fatal asthma flares during chronic salmeterol therapy.

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