MedWire News: Results from a US study suggest that children with mild persistent asthma may benefit from inhaled corticosteroids (ICSs) as rescue medication with a bronchodilator as an effective step-down strategy from daily corticosteroid use.
Such a treatment strategy offers effective protection against exacerbations while reducing the risk for growth retardation associated with daily ISC use, say Fernando Martinez (University of Arizona, Tucson, USA) and team.
To assess the effectiveness of using an ICS (beclomethasone) as a rescue treatment, the team recruited 843 children and adolescents, aged 5-18 years, with well-controlled mild persistent asthma.
After a 4-week run-in period of twice-daily beclomethasone, the participants were assigned to one of four treatment groups.
In total, 71 patients were assigned to take twice-daily beclomethasone with beclomethasone plus a bronchodilator (albuterol) as a rescue treatment (combined group), 72 to twice-daily beclomethasone with placebo plus albuterol as a rescue therapy (daily group), 71 to twice-daily placebo with beclomethasone plus albuterol as a rescue treatment (rescue group), and 74 to twice-daily placebo with placebo plus albuterol as a rescue medicine (placebo group).
Over the 44-week study period, the researchers found that the proportion of patients who experienced exacerbations was significantly lower in the daily, combined, and rescue groups than in the placebo group, at 28%, 31%, and 35% versus 49%, respectively.
Treatment failure rates in the combined, daily, and rescue groups were 5.6%, 2.8%, and 8.5%, respectively, compared with 23.0% in the placebo group.
The researchers also found that patients in the combined and daily groups had 1.1 cm less linear growth than those in the placebo group, while there was no significant difference in linear growth between patients in the rescue and placebo groups.
Martinez and team conclude in The Lancet: "Our data suggest that ICSs used as rescue together with albuterol show benefits over rescue albuterol alone, and avoids the growth effects associated with use of daily inhaled corticosteroids."
In an accompanying commentary, William Checkley (Johns Hopkins University, Baltimore, Maryland, USA) said that employing such a step-down treatment strategy in young people with mild persistent disease "would achieve reduction in overall cumulative exposure to ICSs and obviate concerns about compliance with long-term controller treatment."
However, he added that further research is needed to confirm the safety and benefits of such a strategy.
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; 2011
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