News Release

Occasional rescue therapy for asthmatic children, rather than daily corticosteroids, could manage symptoms without the side effect of growth retardation

Peer-Reviewed Publication

The Lancet_DELETED

Many children use daily inhaled corticosteroids (in the morning and evening) to prevent their asthma flaring up. However, children often have great difficulty adhering to twice daily treatment during long asymptomatic periods. New research published Online First in The Lancet shows that while this remains the most effective way to prevent asthma exacerbations, children could instead use an inhaler only when their symptoms arise (rescue therapy), which would provide relief without the side-effects of growth retardation sometimes seen with daily inhaled corticosteroid use. The study is by Professor Fernando D Martinez, The University of Arizona, Tucson, AZ, USA, and colleagues.

In the study 288 children (including adolescents) were assigned to one of four treatment groups to look at the relative effectiveness of daily treatment and rescue therapy. Children were assigned to one of beclomethasone with beclomethasone plus albuterol (salbutamol) as rescue (combined group, 71 patients); twice daily beclomethasone with placebo plus albuterol as rescue (daily beclomethasone group, 72 patients); twice daily placebo with beclomethasone plus albuterol as rescue (rescue beclomethasone group, 71 patients); and twice daily placebo with placebo plus albuterol as rescue (placebo group, 74 patients).

The researchers found that, compared with the placebo group, the frequency of exacerbations was lower in the daily (28%), combined (31%), and rescue (35%) groups, with the combined and rescue results of borderline statistical significance. 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 (p<0•0001), but not the rescue group, although the rescue group result was not statistically significant.

The authors say: "Rescue beclomethasone can lower the risk of exacerbations and treatment failures, but to a lesser degree than does daily beclomethasone."

They suggest that in order to avoid growth retardation and the need to use daily medication in children with mild persistent asthma, use of rescue inhaled corticosteroid could be an effective step-down alternative to discontinuation of such treatment after asthma control is achieved. They add: "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."

In a linked Comment, Dr William Checkley, Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA, says that current US and UK guidelines recommend daily use of inhaled corticosteroids as both initial and step-up treatment for persistent asthma, with step down only recommended after 3 months of controlled symptoms. He says: "The results of this trial, however, suggest that step-down from daily inhaled corticosteroids to such treatment as rescue in combination with rescue short-acting β agonists could be an effective step-down strategy for patients with mild persistent asthma."

###

Professor Fernando D Martinez, The University of Arizona, Tucson, AZ, USA. T) +1-520-626-5954 E) fernando@arc.arizona.edu

For Dr William Checkley, Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA, please contact David March, Media Relations. T) +1 410 955 1534 E) dmarch1@jhmi.edu / wcheckl1@jhmi.edu

NOTE: IF YOU WISH TO PROVIDE A LINK TO THE FREE ABSTRACT OF THIS PAPER FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62145-9/abstract


Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.