Once-daily budesonide inhalation powder (Pulmicort Turbuhaler) maintains pulmonary function and symptoms of asthmatic children previously receiving inhaled corticosteroids

Background and Aim. Compliance with long-term inhaled therapy in asthma is often poor, but it is likely to be improved with a simplified administration, once daily.The present study was designed to assess whether, in childhood asthma, a single dose of nebulized beclomethasone dipropionate once daily was as effective and safe as the same total daily dose administered twice daily. Methods. Asthmatic children, not treated with inhaled steroids for at least a month preceding the study and using short-acting bronchodilators more than once a week were enrolled in a double-blind, double dummy, randomised, multicentric study. After a two week run-in period on nebulised twice daily 400 mcg beclomethasone dipropionate, patients were randomly assigned to twelve weeks of treatment with 800 mcg nebulised beclomethasone dipropionate daily, either in single dose (o.d. group) or divided into two 400 mcg doses (b.i.d. group). Results. 65 children (mean age 8.6 years, mean FEV1 81% of predicted), were valuable for intention to treat. During the run-in period, a significant improvement in FEV1, FVC, morning and evening PEF values and clinical scores was observed. Children then entered the randomised trial: 32 were included in the o.d. group and 33 in the b.i.d. group. During the twelve week treatment period, the observed improvement in pulmonary function parameters was maintained in both treatment groups. Morning and evening PEF showed a progressive slight increase as well as PEF diurnal variability showed a progressive reduction in the two treatment groups during the whole study period without reaching statistical significance. Moreover, in both treatment groups a similar progressive increase in symptom free nights and days and in the percentage of children achieving total asthma symptoms control was detected. Finally, no significant changes in urinary cortisol/creatinine ratio were observed throughout the study period and between groups. Conclusions. A daily dose of 800 mcg of beclomethasone, administered for twelve weeks with a nebuliser either once or twice daily provide similar efficacy in maintaining pulmonary function and symptoms of asthmatic children, with a good tolerability profile.

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Adrenal Function and Linear Growth in Asthmatic Children Treated with High Dose Inhaled Corticosteroids (ICS)

Pediatric Research ◽

10.1203/00006450-199809000-00248 ◽

1998 ◽

Vol 44 (3) ◽

pp. 455-455

Author(s):

C Dunlop ◽

J McNaboe ◽

H J Steen ◽

D Carson ◽

B Sheridan ◽

...

Keyword(s):

Linear Growth ◽

Inhaled Corticosteroids ◽

Adrenal Function ◽

High Dose ◽

Asthmatic Children

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Grading, Time Course, and Incidence of Exercise-Induced nduced Airway Obstruction and Hyperinflation in Asthmatic Children

PEDIATRICS ◽

10.1542/peds.56.5s.868 ◽

1975 ◽

Vol 56 (5s) ◽

pp. 868-879

Author(s):

Gerd J. A. Cropp ◽

I. J. Schmultzler

Keyword(s):

Pulmonary Function ◽

Airway Obstruction ◽

Clinical Status ◽

Small Airway ◽

Strenuous Exercise ◽

Normal Children ◽

Asthmatic Children ◽

Ergometer Exercise ◽

Exercise Induced ◽

Small Airway Obstruction

We evaluated clinical status and pulmonary function in 60 perennially asthmatic and 11 normal children before and repeatedly after incrementally increasing bicycle ergometer exercise. The changes in clinical status and pulmonary function which were elicited by strenuous exercise were graded by an air exchange and a physiological grading system respectively. Normal children showed no significant clinical or physiological changes after exercise. Strenuous exercise elicited significant deteriorations in clinical and physiological measurements in 36% to 77% of asthmatic girls and 46% to 90% of asthmatic boys, the frequency depending on the test used to determine exercise-induced abnormalities. The incidence of exercise-induced asthma (EIA) was statistically significantly higher in asthmatic boys than girls. The higher incidence of EIA in boys was primarily due to a larger number of very severe attacks in boys than girls; mild and moderate EIA was about equally common in the two sexes. Most patients with EIA developed large and small airway obstruction, although large airway obstruction tended to be the predominant and the more severe abnormality. Clinical and physiological abnormalities, regardless of severity, were usually most marked during the first ten minutes after exercise and lessened thereafter. Mild EIA usually lasted for only 15 minutes or less; severe EIA improved, but usually did not resolve within 35 minutes of exercise. There were three patients in whom the severity of EIA got worse after exercise and an additional seven in whom the improvement was minimal. In these ten patients isoproterenol aerosol terminated EIA, indicating that exercise-induced large and small airway obstruction in asthmatic children is primarily. if not solely. due to bronchospasm.

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EFFICACY OF CROMOGLYCATE IN PERSISTENTLY WHEEZING INFANTS

PEDIATRICS ◽

10.1542/peds.96.2.401 ◽

1995 ◽

Vol 96 (2) ◽

pp. 401-401

Author(s):

Thad H. Joos

Keyword(s):

Pulmonary Function ◽

Sodium Cromoglycate ◽

Inhaled Corticosteroids ◽

Face Mask ◽

Young Group ◽

Young Infants ◽

Active Medication ◽

Symptom Scores ◽

Study Population ◽

Complicating Factors

Purpose of the Study. To evaluate the effectiveness of sodium cromoglycate in the treatment of persistent wheezing in children ages 4 to 12 months. Study Population. Thirty-one asthmatic infants without such complicating factors as gastroesophageal reflux, cystic fibrosis, bronchopulmonary dysplasia, etc, were enrollled. Sixteen received active medication and 15 received placebo. Methods. All 31 infants were observed for 3 weeks before the final enrollment with symptom scores recorded based on cough, wheeze, thoracic indrawing, and sleep pattern. Any noticeable problems were treated with albuterol delivered by a nebulizen and tightly fitting face mask. Pulmonary function parameters were determined by the "squeeze technique" on all enrollees. For the next 6 weeks, 16 infants received 40 mg of sodium cromoglycate in 4 mL solution via the nebulizer three times a day and 15 infants received 4 mL of normal saline three times a day. Symptom scores were meticulously recorded and again pulmonary function studies were performed. Findings. There were no significant differences noted between the sodium cnomoglycate group or the placebo group that led the investigators to conclude that sodium cromoglycate was not an effective agent in controlling asthma in very young infants. Reviewer's Comments. This appeared to be a very well done investigation and employed twice the dose of sodium cromoglycate e.g. 40 mgm tid, than most of us would use. It certainly makes one wonder especially in view of Dr. Shirley Murphy's similar results with sodium cromoglycate in premature newborns and its failure to prevent BPD. The use of inhaled corticosteroids to manage asthma in this young group of patients deserves such a carefully conducted study.

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