By Christian Duffin, Nigel Praities
The risk of serious adverse effects from the long-term use of inhaled corticosteroids in children could be reduced by switching from daily dosing to just using it for symptom relief, say researchers.
Their study – published by the Lancet today – concluded that the risk-benefit favoured using ‘rescue’ inhaled corticosteroid as an effective step-down alternative to twice daily maintenance treatment in children with mild asthma.
They found that the use of rescue inhaled corticosteroid reduced the risk of an exacerbation by around a third, improve compliance and avoid growth retardation.
They made these conclusions after a 44-week randomised, double-blind, placebo-controlled trial to examine the comparative effectiveness of different treatment regimes among 288 children and adolescents aged 5-18 with mild persistent asthma.
The participants were assigned to one of four similarly sized groups. One group (the combined group) took twice daily beclomethasone with beclomethasone plus albuterol as rescue, while another took twice daily beclomethasone with placebo plus albuterol as rescue (daily beclomethasone group).
A third group took twice daily placebo with beclomethasone plus albuterol as rescue (rescue beclomethasone group), and the final group used a twice daily placebo plus placebo and albuterol as rescue (the placebo group).
The researchers found that, compared with the placebo group, the frequency of exacerbations was 28% lower in the daily group, 31% lower in the combined group and 35% in the rescue group, although the combined and rescue results were not statistically significant.
The researchers were led by Professor Fernando Martinez, director of the Arizona Respiratory Center at the University of Arizona, USA. They concluded: ‘We speculate that rescue inhaled corticosteroids could also be an alternative, step 2 therapeutic approach for mild persistent asthma even in individuals who have not previously received a course of daily corticosteroid treatment, but our study was not designed to specifically address this issue.’
Frequency of treatment failure was 23% in the placebo group, compared with 6% in the combined, 3%, and 8.5% in the rescue groups. Compared with the placebo group, linear growth was 1.1cm less in the combined and daily arms, but not the rescue group, although the rescue group result was not statistically significant.
In an editorial in the same issue, Dr William Checkley, instructor assistant professor at Johns Hopkins University, Baltimore, said the study suggested current US and UK guidelines could change.
‘The results of this trial suggest that step-down from daily inhaled corticosteroids to such treatment as rescue in combination with rescue short-acting ? agonists could be a reasonable step-down strategy for patients with mild persistent asthma.
‘Such a strategy would achieve reduction in overall cumulative exposure to inhaled corticosteroids and obviate concerns about compliance with long-term controller treatment,’ he said.
Rescue steriods ‘effective in children with controlled asthma’