Efficacy of Fluticasone Propionate on Lung Function and Symptoms in Wheezy Infants

Abstract

The role of inhaled corticosteroids in the treatment of recurrent or persistent wheeze in infancy remains unclear. We evaluated the effect of 3 months of treatment with inhaled fluticasone propionate, 200 microg daily (FP200), on lung function and symptom scores in wheezy infants. Moreover, we evaluated whether infants with atopy and/or eczema respond better to FP200 as compared with non-atopic infants. Forced expiratory flow (Vmax(FRC)) was measured at baseline and after treatment. Sixty-five infants were randomized to receive FP200 or placebo, and 62 infants (mean age, 11.3 months) completed the study. Mean Vmax(FRC), expressed as a Z score, was significantly below normal at baseline and after treatment in both groups. The change from baseline of Vmax(FRC) was not different between the two treatment arms. After 6 weeks of treatment, and not after 13 weeks, the FP200 group had a significantly higher percentage of symptom-free days and a significant reduction in mean daily cough score compared with placebo. Separate analysis of treatment effect in infants with atopy or eczema showed no effect modification. We conclude that in wheezy infants, after 3 months of treatment with fluticasone, there was no improvement in lung function and no reduction in respiratory symptoms compared with placebo.

Use of inhaled corticosteroids decreases hospital admissions for asthma in young children

“…[19] In addition, recent controlled clinical trials have failed to show any subsequent long-term benefi ts of ICS after the discontinuation of the treatment in less than 24-month-old children. [20][21][22] Despite long-term benefi ts were lacking, ICSs diminished wheezing symptoms as long as they were consumed, [20,21] which is in line with the present results at the population level. Regional treatment policies seem to exert infl uence on the hospitalization rates, indicating the role of ICSs in the prevention of asthma exacerbations in young children (Table 3).…”

Exhaled Nitric Oxide Differentiates Airway Diseases in the First Two Years of Life

“…FE NO measurements were conducted in 118 infants with different respiratory diseases, who either participated in other clinical trials (15) or were referred to the Department of Pediatric Respiratory Medicine, Sophia Children's Hospital in Rotterdam, to perform lung function tests as part of the routine patient care. As the control group we took a random sample of 100 healthy infants participating in an ongoing birth cohort study (16).…”

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

“…In a post hoc analysis of two large randomised controlled trials in young children (aged 12-47 months), those with frequent symptoms, aged .2 yrs and/or with a family history of asthma showed the best response to treatment with fluticasone (200 mg?day -1 ), whereas those with less frequent symptoms, without a family history of asthma and aged ,2 yrs showed no significant treatment effect [111]. Two recent studies using inhaled fluticasone to treat wheezy infants and preschool children failed to find any improvement in lung function [112,113]. Atopic markers, such as a history of atopic dermatitis or allergic rhinitis, did not improve the chance of responding to ICSs [111].…”