Corticosteroids For Childhood Asthma Not Effective As A Preventative Treatment
It seems, say the researchers, that inhaled corticosteroid treatment does nothing to alter the course of asthma in children and babies. They stressed that steroids still have a useful role to play with children who have frequent symptoms.
One study was carried out in the USA, while the other was done in Denmark.
You can read about these studies in the New England Journal of Medicine (JEJM), May 11 issue (links at the end of this article).
The theory was that corticosteroids may prevent the damaging effects of asthma in the lungs, as the airway inflammation that brings on asthma is usually accompanied by lung damage. If the corticosteroids were inhaled during an infant's first year, while his/her lungs are developing, researchers had thought the steroids might prevent long-term damage.
The Danish study, led by Dr. Hans Bisgaard, Copenhagen University Hospital, included 411 babies who had been diagnosed with asthma. They were enrolled when they were one month old and administered either inhaled corticosteroids or a placebo as soon as they had one wheezing episode - the treatment lasted two weeks. The babies' parents also gave standard asthma relieving medications when symptoms were evident.
Over the next three years, the difference in the frequency of episodes was virtually the same for the two groups. The inhaled corticosteroid group had a symptom-free day rate of 83%, and 82% for the placebo group. Persistent wheezing, throughout this period, was experienced by 24% of the corticosteroids group and 21% of the placebo group.
The researchers concluded that inhaled corticosteroids treatment did nothing to prevent the progression from episodic to persistent wheezing. Even in the short term, there were no benefits during episodes of wheezing - during the babies' first three years.
This is an example, said the researchers, of the danger of extrapolating from adult studies and applying them to children.
The American study, American Prevention of Early Asthma in Kids (PEAK) study, team leader, Dr. Theresa Guilbert, University of Arizona College of Medicine, did find some short-term symptom control benefits, but no long-term benefits - the course of the children's asthma progressions was not altered with inhaled corticosteroids.
This study looked at two to three year olds, 285 of them. They were all at very high risk for asthma. The children were treated with inhaled corticosteroids, fluticasone, or a placebo. Treatment lasted two years. Monitoring continued for a whole year after treatment was stopped.
While the children were receiving their twice-a-day treatment:
-- 93% of the treatment group had episode-free days
-- 88% of the placebo group had episode-free days
During the year they were not receiving treatment, but being monitored:
-- 87% of the former-treatment group had episode-free days
- 86% of the former-placebo group had episode-free days
During the treatment period, the treatment group grew taller at a faster rate and ended up 1.1cms taller than the placebo group. By the end of the monitoring year in which no treatment was used, the differences between the two group's heights narrowed to 0.7cm.
The researchers concluded that inhaled steroids did help children while they were on them. But the treatment did nothing to prevent the progression of the course of their asthma.
Click here to read about the Danish study in the NEJM
Click here to read about the American study in the NEJM
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