Children with mild asthma: do they benefit from inhaled corticosteroids?

Abstract

In children with mild asthma, who show hardly any abnormalities in pulmonary function, objective measurement of the effect of inhaled corticosteroids is difficult.The short term effect of fluticasone propionate (FP) in these children was evaluated, using both subjective and objective parameters. A total of 68 children (5-10 yrs old) were randomly assigned to either FP 250 mg or placebo twice daily as metered-dose inhaler via spacer during 12 weeks. Symptom scores, use of rescue medication, wheezing, parent global evaluation and pulmonary function tests including forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) and bronchial responsiveness (provocation dose of methacholine causing a 20% fall in FEV1 (PD20)) were evaluated.FP-treated versus placebo-treated children showed significant changes in percentage symptom-free days, use of b 2 -mimetics, morning and evening PEF, FEV1 % pred and wheezing. No significant improvements were found in parent global evaluation, absolute values of FEV1 nor PD20.These findings show that inhaled corticosteroids are effective in children with mild asthma. This effect can be assessed by both objective and subjective parameters. Early start of inhaled corticosteroids should be considered even when pulmonary function is normal.

Understanding mild persistent asthma in children: The next frontier

“…For 6 months before enrollment, 27.6% of children had used cromolyn and 22.6% had used ICSs 2 times weekly. In the study by Arets et al, 33 6 children had received maintenance treatment with ICSs. Diary symptom score; scale, 0 to 3.…”

“…In the study by Arets et al, 33 68 children age 5 to 10 years were randomized to receive fluticasone propionate 250 mg twice daily via metered-dose inhaler with spacer or placebo for 12 weeks. Compared with placebo, children receiving fluticasone had significant improvements in symptom-free days, use of rescue b 2 -adrenergic agonist, wheezing, and pulmonary function.…”

Measures of asthma control

“…The American Thoracic Society/European Respiratory Society guidelines recommend that the frequency and intensity of asthma symptoms as well as their impact on patient activities be included in asthma diaries [1]. A measure of lung function such as peak expiratory flow rate (PEF) and/or spirometry (FEV1) is often included in asthma diaries [3,[6][7][8]. A measure of lung function such as peak expiratory flow rate (PEF) and/or spirometry (FEV1) is often included in asthma diaries [3,[6][7][8].…”

“…There are potential concerns with the use of paper diaries including the risk of missing substantial amounts of data, retrospectively completed data, incorrect data, or fabricated data [11][12][13]. In analyzing data derived from asthma diaries, mixed model (or other equivalent) analyses should be used so as to account for the large quantity of longitudinal data [7,8,10,16]. There are currently no standardized validated handheld electronic asthma diaries for use in clinical practice or clinical trials.…”

Gene expression in CD4+ T-cells reflects heterogeneity in infant wheezing phenotypes

“…The patients were 6-yr-old children with TW and PW who had previously participated in another study because of recurrent or chronic wheeze episodes at the age of 1-4 yrs [24]. Since they were included as having shown early wheeze, their history of wheezing was well documented and, therefore, these children could be identified as showing TW or PW at the age of 6 yrs.…”