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29-11-2011 | Immunology | Article

Daily no better than intermittent asthma treatment in toddlers


Free abstract

MedWire News: An intermittent high-dose regimen of budesonide achieves similar results to a daily low-dose regimen of the same drug for reducing asthma exacerbations in toddlers, show study results.

"We wanted to understand how to best treat young children who have repeated episodes of wheezing, most of whom appear symptomatic just when they have colds," said study investigator Leonard Bacharier (Washington University, St Louis, Missouri, USA) in a press statement.

"Our goal was to start therapy at the first signs of a viral respiratory tract infection or cold to interrupt or slow the progression of symptoms. This trial was aimed to try to prevent wheezing severe enough that requires oral steroids and really gets in the way of children's lives."

Daily glucocorticoids are currently recommended for young children with asthma to prevent wheezing, but there are concerns about adherence and possible adverse effects on growth, the authors explain.

Writing in the New England Journal of Medicine, Robert Zeiger (Kaiser Permanente, San Diego, California, USA) and colleagues report the study of 278 children with asthma (positive values on the modified asthma predictive index) between the age of 12 and 53 months.

The children were randomly assigned to receive treatment with daily low-dose budesonide (0.5 mg/day) or intermittent high-dose budesonide (1 mg twice daily for up to 7 days, starting as soon as respiratory tract illness or other cause triggered symptoms) in an inhalable format for 1 year. The children on the daily regimen received placebo inhalers in the morning during respiratory tract illness to provide a better comparison with the intermittent high-dose group.

Efficacy of treatment was assessed according to the frequency of asthma exacerbations requiring oral glucocorticoid therapy in each group over the follow-up period.

The frequency of oral glucocorticoid treatment was not significantly different between the two groups at study completion. In addition, the mean exposure to inhaled budesonide was 104 mg less in the intermittent than in the daily budesonide group at 1 year.

These results indicate that there are several treatment regimens that can be used to treat children with recurrent wheezing, said Bacharier.

"While daily therapy continues to be the recommended approach, in this group of children, whose disease is really evident only during respiratory tract illnesses with very few or no symptoms outside of that, instructing parents to treat them at the earliest signs of illness with a high dose of inhaled steroid diminishes the likelihood of an episode of illness requiring oral steroids comparable to giving them daily therapy," he commented.

By Helen Albert

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