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JACI Highlights - January 2007
Sorkness et al – Long-term comparison of three controller regimens for mild-moderate persistent childhood asthma: The Pediatric Asthma Controller Trial (PACT)
In the January 2007 issue of the Journal of Allergy and Clinical Immunology, Sorkness and colleages study long-term treatment of mild to moderate persistent asthma in school-aged children. This is the first study to directly compare three different asthma medicines used for initial daily therapy for children with this degree of asthma severity. Current recommendations in national and international asthma guidelines for the initial treatment of children are based either on studies in children of single treatments compared to a placebo or comparison studies in adults. The Sorkness study compared the efficacy and potential growth effects of a low dose inhaled corticosteroid (200 mcg fluticasone a day); a combination of a lower dose inhaled corticosteroid and an inhaled long acting beta2 agonist (100 mcg fluticasone each morning plus 50mcg salmeterol twice daily), and a leukotriene receptor antagonist (montelukast). Sorkness and colleagues found that the inhaled corticosteroid used alone gave the highest level of asthma control. In addition, the researchers found no significant growth effects with any of the three treatments. These results support the current asthma guidelines, which recommend inhaled corticosteroids as the preferred initial therapy for children with mild to moderate asthma. Another important study finding is that even in the group that received the most effective medicine, asthma was controlled on just 64% of days over the 48 week study. This indicates the importance of monitoring children’s response to therapy in order to make appropriate adjustments. It further indicates the need for new medicines that can gain more complete control of asthma in school-aged children with mild to moderate asthma.
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