Further data oppose inhaled steroids in child wheeze
The strategy of giving inhaled corticosteroids to wheezy children to prevent the development of asthma has lost further ground with new data published in The
Lancet (2006;368:754).
Researchers found that inhaled fluticasone propionate given to preschool
children with wheeze did not affect the natural history of asthma or
wheeze later in childhood, adding support to studies
with similar findings published earlier this year (PJ, 13 May, p558).
The research, which saw the follow-up of 173 children up to five years
of age, showed no difference in measures of wheeze or asthma, or in the
use of asthma medicines between fluticasone- and placebo-treated patients.
In addition, no improvement in lung function was reported.
In fact, according to the authors, a subgroup analysis reveals that children
in the treatment group had poorer lung function than those in the placebo
group, as measured by post-bronchodilator specific airway resistance
(SRaw). The same effect was not seen for forced expiratory volume in
one second (FEV1).
They say: “Although the significance of this finding is unclear,
there remains a possibility that early use of inhaled corticosteroids
in very young children could be detrimental
to lung development, which is thought to continue over the first few
years of life.”
A small improvement in symptom scores (P=0.02) and unscheduled visits
to a doctor for wheeziness (P=0.05) was seen in the third month of the
study only.
The authors conclude that prescribers should not rush into treating intermittent
infantile wheeze with inhaled corticosteroids due to the lack of long-term
benefit in their study population and the small benefit seen for symptoms. |
The
Pharmaceutical Journal
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