Corticosteroids not advised for halting future asthma
Using inhaled corticosteroids in young children to prevent the future development of asthma has been called into question by two studies published in The
New England Journal of Medicine this week.
In the first study (2006;354:1985), Theresa Guilbert from the Arizona
Respiratory Centre, University of Arizona, and colleagues found that
long-term inhaled corticosteroid therapy in pre-school-aged children
does not offer improvement in lung function or in the development of
asthma symptoms after the treatment has ceased.
The investigators randomised 285 children (aged two or three years and
at high risk of developing asthma) to receive inhaled fluticasone or
placebo for two years, followed by a treatment-free year of observation.
During the observation year, the authors saw no difference in episode-free
days (days without asthma-like symptoms, unscheduled medical consultations
for respiratory reasons or symptomatic use of reliever medicines), the
number of exacerbations or lung function between the two groups.
Furthermore, the authors found that, at the end of the observation period,
children in the corticosteroid group had a mean increase in height of
0.7cm less than those in the placebo group (P=0.008).
During the treatment period, children receiving inhaled corticosteroid
had more episode-free days (P=0.006), had fewer exacerbations (P<0.001)
and relied less on reliever medicines (P<0.001). The authors conclude
that although the treatment reduced the burden of illness, inhaled corticosteroids
should not be prescribed with the sole aim of preventing future asthma
in high-risk children in this age group.
In the second study (ibid, p1998), Hans Bisgaard and colleagues from
the Danish Paediatric Asthma Centre, Copenhagen University Hospital,
examined the use of inhaled corticosteroids over a period of three years
in an even younger group of children.
Infants from one month of age were randomised to receive either two weeks’ treatment
with budesonide or placebo on an episodic basis, initiated only after
three days of wheeze.
Intermittent corticosteroid treatment throughout the first three years
of life had no short-term effect on wheezing and did not change the likelihood
of the children’s episodic wheezing becoming persistent. The researchers
found no difference in height or bone mineral density between the two
groups. |
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Pharmaceutical Journal
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