SELECTED ARTICLES FROM THE RECENT LITERATURE 2007

August 23, 2007

Daily vs as - needed inhaled corticosteroid for mild persistent asthma

Summary
Background - Several asthma treatment guidelines recommend continuous treatment of mild persistent asthma (MPA) with inhaled corticosteroids (ICS). However, some recent studies suggested that as - needed ICS treatment may be sufficient for MPA.

Findings - Turpeinen et al of Helsinki Univ Hospital carried out a comparison of Group 1) continuous budesonide (Bud) 400 mcg b.i.d. for one month, 200 mcg b.i.d. for the next 5 months then 100 mcg b.i.d. during months 7-18; Group 2) the same continuous Bud treatment during the first month, then as needed use for increased symptoms during months 7-18; Group 3) cromolyn 10 mg t.i.d for months 1-18 . This comparison was carried out in 176 children (ages 5-10 years) with MPA.

They found that the asthma in children in Groups 1 and 2 was controlled significantly better than in Group 3. During the 7-18 month period the children in Group 1 had significantly fewer exacerbations than the Group 2 children but the frequency of asthma free days did not differ significantly in Groups 1 and 2.

The decreased growth velocity rate of children in Groups 1 and 2 during the first 6 months increased to a normal rate during the 7-18 month period in Group 1 children. The growth of the children in Group 2 actually "caught-up" to the normal predicted values during the 7-18 month period.

Reference
Arch Dis Child 2007, July 18

Editor's Comments
These findings add to a body of recent findings comparing continuous vs as- needed ICS treatment of MPA. This study showed that continuous ICS treatment may result in fewer exacerbations but there may not be the catch up during the 7-18 month period from ICS-induced decreases in growth velocity. Such catch up occurs during as- needed ICS treatment. It may well be that a sub-population of children with MPA can be treated effectively with as - needed ICS provided that the parents are adequately instructed and the child well monitored.

 

<-- BACK