MedWire News: Treatment with standard doses of inhaled corticosteroids (ICS) plus a long acting β2-agonist (LABA) is more effective for reducing asthma symptoms in children with poorly-controlled disease than simply increasing the ICS dose, research indicates.
“In asthmatic children whose symptoms are uncontrolled on standard doses of ICS, guidelines recommend to either increase the ICS dose or to add further controller medication, eg, a LABA,” explain Monika Gappa (Marienhospital, Wesel, Germany) and team in the journal Pediatric Pulmonology.
“However, in children there is little evidence to support preferral of one of these therapeutic options compared to the other,” they add.
To investigate further, the researchers studied 283 children, aged between 2 and 16 years, with persistent asthma symptoms despite low-dose ICS treatment.
The children were divided into two groups to receive either twice their previous dose of ICS treatment (fluticasone 200 µg twice daily) or their usual dose of ICS plus the addition of a LABA (fluticasone 100 µg/salmeterol 50 µg twice daily) in a single inhaler.
The researchers found that, after 8 weeks, children taking the combination treatment (n=138) showed significantly greater improvements in their morning peak expiratory flow than those assigned to the double ICS dose, at an average of 30.4 l/min compared with 16.7 l/min, respectively.
Children assigned to the combination treatment also experienced 8.7% more days without asthma symptoms and 8.0% more days without reliever medications than the other children.
Furthermore, children taking the combination treatment achieved a longer average period of good asthma control than those taking the double ICS dose, at 3.4 compared with 2.7 weeks, respectively.
Both treatments were generally well tolerated, with 78 adverse events occurring in 43 children in the combination treatment group and 82 events occurring in 44 children in the ICS only group.
Gappa and team conclude: “These outcomes suggest that the ICS LABA combination treatment is more effective in children than double dose ICS therapy and probably equally safe.”
They add: “Our results support adult data and confirm current pediatric guideline recommendations to use ICS LABA combination therapy as the preferred step up option for children inadequately controlled on low dose ICS monotherapy.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
Free abstract
