Rescue steroid option for asthma
Using an inhaled corticosteroid as rescue therapy may offer an effective step-down treatment strategy in young people with mild persistent asthma controlled by daily corticosteroid therapy, suggest researchers in The Lancet.
In a randomised trial, they found that rescue corticosteroid plus bronchodilator therapy was more effective at preventing exacerbations than rescue bronchodilator alone, while avoiding the risk of growth retardation associated with continued daily corticosteroid use.
Professor Fernando Martinez (University of Arizona, Tucson, USA) and colleagues studied 288 children and adolescents, who had well-controlled symptoms on twice-daily inhaled beclomethasone dipropionate and rescue inhaled albuterol during a 4-week run-in phase.
As expected, patients who then continued to receive twice-daily beclomethasone, either with rescue beclomethasone plus albuterol or rescue albuterol alone, had reduced risks of exacerbation over the 44-week study compared with those who received rescue albuterol only (placebo).
Patients who stopped daily beclomethasone and took it only as rescue therapy in combination with rescue albuterol also had a lower risk of exacerbation than the placebo group. Although the risk reduction was only marginally significant, these patients had no reduction in linear growth compared with the placebo group, whereas the patients who continued on daily beclomethasone grew an average of 1.1 cm less.
Writing in a related editorial, Dr William Checkley (Johns Hopkins University, Baltimore, Maryland, USA) agreed that switching to corticosteroids as rescue in combination with rescue short-acting beta-agonists could be a reasonable step-down strategy, which he says "would achieve reduction in overall cumulative exposure to inhaled corticosteroids and obviate concerns about compliance with long-term controller treatment".
But he calls for further randomised studies, in particular to determine whether such a strategy risks side effects when daily treatment is discontinued.
GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Caroline Price