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Corticosteriod maintenance therapy 'no better than occasional high doses' for asthma

A low, daily dose of budesonide is no better than an intermittent high-dose regimen at reducing asthma exacerbations in young children, new research suggests.

Researchers investigated 278 children aged between 12 and 53 months with recurrent wheezing and at least one exacerbation in the previous year.

Children received a budesonide inhaler for one year either in an intermittent high-dose regimen – 1mg twice daily for seven days at onset of a respiratory tract illness – or a low-dose daily regimen of 0.5mg nightly. Matched placebos were given.

Exacerbation frequency did not differ between groups, with rates per patient-year of 0.97 and 0.95 in the daily and intermittent groups respectively. There was no difference in the time to first exacerbation, rates of respiratory illnesses, symptom scores or proportion of patients with adverse events. But mean exposure to budesonide was 104mg less for patients in the intermittent group.

Global Initiative for Asthma (GINA) guidelines recommend daily control, including use of inhaled steroids, for young children with a history of wheezing, suggestive of asthma.

Study leader Dr Robert Zeiger, clinical professor of paediatrics at the University of California, said these results ‘may be important in the preparation of future guidelines'.

New England Journal of Medicine 2011 24 November online

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