Long-Term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma

University of California, San Diego, San Diego, California, United States
New England Journal of Medicine (Impact Factor: 55.87). 06/2006; 354(19):1985-97. DOI: 10.1056/NEJMoa051378
Source: PubMed


It is unknown whether inhaled corticosteroids can modify the subsequent development of asthma in preschool children at high risk for asthma.
We randomly assigned 285 participants two or three years of age with a positive asthma predictive index to treatment with fluticasone propionate (at a dose of 88 mug twice daily) or masked placebo for two years, followed by a one-year period without study medication. The primary outcome was the proportion of episode-free days during the observation year.
During the observation year, no significant differences were seen between the two groups in the proportion of episode-free days, the number of exacerbations, or lung function. During the treatment period, as compared with placebo use, use of the inhaled corticosteroid was associated with a greater proportion of episode-free days (P=0.006) and a lower rate of exacerbations (P<0.001) and of supplementary use of controller medication (P<0.001). In the inhaled-corticosteroid group, as compared with the placebo group, the mean increase in height was 1.1 cm less at 24 months (P<0.001), but by the end of the trial, the height increase was 0.7 cm less (P=0.008). During treatment, the inhaled corticosteroid reduced symptoms and exacerbations but slowed growth, albeit temporarily and not progressively.
In preschool children at high risk for asthma, two years of inhaled-corticosteroid therapy did not change the development of asthma symptoms or lung function during a third, treatment-free year. These findings do not provide support for a subsequent disease-modifying effect of inhaled corticosteroids after the treatment is discontinued. (ClinicalTrials.gov number, NCT00272441.).

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Available from: Lynn M Taussig, Dec 24, 2014
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    • "Some asthma patients develop AHR in association with airway remodeling [12]. Furthermore, severe asthmatic patients under anti-inflammatory treatments will present loss in lung function despite inflammation being controlled [13]. These facts illustrate that underlying non-inflammatory mechanisms regulate airway structure and function, which include epithelial thickening and subepithelial collagen deposition. "
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    • "However, in preschool children data are unavailable. Recent early intervention studies with ICS in young children, aimed at the prevention of asthma, have shown no beneficial results with respect to the development of asthma [33–35], and the results of therapeutic studies are conflicting. An explanation may be that wheezing and coughing at such a young age may be present in a number of different disease entities, with different aetiologies, and it therefore remains difficult to select an effective treatment strategy. "
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    12/2012; 2012:674204. DOI:10.6064/2012/674204
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    • "Currently, allergies are in most cases treated by short-term symptom relieving or long-term anti-inflammatory drugs [31-33]. The introduction of the latter, of which corticosteroids are the most prominent, has reduced some of the more serious outcomes of these diseases [34]. "
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