New regimen of inhaled corticosteroid in preschool children with asthma

Dae Hyun Lim; Jeong Hee Kim; Byong Kwan Son

doi:10.5124/jkma.2012.55.12.1201

J Korean Med Assoc > Volume 55(12); 2012 > Article

Lim, Kim, and Son: New regimen of inhaled corticosteroid in preschool children with asthma

Continuing Education Column

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2012; 55(12): 1201-1206.

Published online: December 18, 2012

DOI: http://dx.doi.org/10.5124/jkma.2012.55.12.1201

New regimen of inhaled corticosteroid in preschool children with asthma

Dae Hyun Lim, MD^1,², Jeong Hee Kim, MD^1,², Byong Kwan Son, MD^1,²

¹Department of Pediatrics, Inha University School of Medicine, Incheon, Korea.

²Environmental Health Center for Allergic Disease, Ministry of Environment, Gwacheon, Korea.

Corresponding author: Dae Hyun Lim, dhyunlim@inha.ac.kr

Received November 14, 2012 Accepted November 28, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Daily low-dose inhaled corticosteroid in preschool children with asthma is recommended to prevent the development of asthma symptom and sign based on many asthma management guidelines. But the retarded growth after long-term steroid inhalation has been concerned. Recently the method of intermittent high-dose (suspension, 1,000 µg, 2 times a day for 7 days) budesonide inhalation when the initial phase to develop the asthma exacerbation was studied to compare the efficacy and safety with daily low-dose budesonide (500 µg) inhalation regimen in preschool children positive with modified asthma predictive index in recurrent wheezer during the study period with 52 weeks. There were no significant difference between two regimen with respect to the frequency of exacerbations, the time to the first exacerbation and to the second exacerbation, and the frequency of treatment failure. The total exposure to budesonide over the period was less in the intermittent high-dose regimen than in the daily low-dose regimen. There were no significant difference in change in height. But the change in height from baseline in intermittent high-dose regimen group was 8.01 cm and in daily low-dose was 7.76 cm. We need the more clinical studies in preschool children with persistent moderate and severe asthma and in various country and nations. It is suggested the intermittent high-dose budesonide inhalation regimen in preschool children with freqeunt wheezing may be a very good alternative to control the allergic inflammation and symptoms of asthma without concerning the adverse effect of steroid.

Asthma; Child; Inhaled corticosteroid

Acknowledgements

This study was supported by a grant from the Ministry of Environment, Korea.

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Figure 1

Correlation between pathologic mechanisms and clinical consequences in asthma (From Bousquet J, et al. Am J Respir Crit Care Med 2000;161:1720-1745, according to the Creative Commons License) [10].

Figure 2

Bimonthly proportion of episode-free days during the two-year treatment period and the observation period. Fluticasone treatment, as compared with placebo, did not increase the proportion of episode-free days during the observation year (86.8% [95% confidence interval {CI}, 81.2 to 90.9] vs. 85.9% [95% CI, 79.9 to 90.3], P=0.78), but during the two-year treatment period (shaded area) it significantly increased the proportion of episode-free days (93.2% [95% CI, 91.1 to 94.9] vs. 88.4% [95% CI, 84.9 to 91.2], P=0.006). The proportions of episode-free days in the fluticasone group and the placebo group were 97% and 96%, respectively, during the first two months of the treatment period; 96% and 89% during the last two months of the treatment period; and 84% and 87% during the last two months of the observation year-results that demonstrate an increase in the frequency of asthma-like symptoms over time. The two study groups were compared by analysis of covariance at each two-month interval. P-values are for the comparison between the groups at each interval. Vertical bars represent 95% CI (From Guilbert TW, et al. N Engl J Med 2006;354:1985-1997, according to the Creative Commons License) [12].