Inhaled steroids helpful as combined rescue treatment in mild asthma

January 01, 0001

Inhaled steroids helpful as combined rescue treatment in mild asthma

The researchers assessed the effectiveness of an inhaled corticosteroid (beclomethasone dipropionate) used as rescue treatment. In this 44-week, randomised, double-blind, placebo-controlled trial they enrolled children and adolescents with mild persistent asthma aged 5—18 years from five clinical centres in the USA. Participants were randomly assigned to one of four treatment groups: twice daily beclomethasone with beclomethasone plus albuterol as rescue (combined group); twice daily beclomethasone with placebo plus albuterol as rescue (daily beclomethasone group); twice daily placebo with beclomethasone plus albuterol as rescue (rescue beclomethasone group); and twice daily placebo with placebo plus albuterol as rescue (placebo group). Twice daily beclomethasone treatment was one puff of beclomethasone (40 microg per puff) or placebo given in the morning and evening. Rescue beclomethasone treatment was two puffs of beclomethasone or placebo for each two puffs of albuterol (180 microg) needed for symptom relief.

Compared with the placebo group (49%), the frequency of exacerbations was lower in the daily (28%), combined (31%), and rescue (35%) groups. Frequency of treatment failure was 23% in the placebo group, compared with 5.6% in the combined, 2.8% in the daily, and 8·5% in the rescue groups. Compared with the placebo group, linear growth was 1.1 cm less in the combined and daily arms, but not the rescue group. Only two individuals had severe adverse events; one in the daily beclomethasone group had viral meningitis and one in the combined group had bronchitis.

The researchers concluded: "Children with mild persistent asthma should not be treated with rescue albuterol alone and the most effective treatment to prevent exacerbations is daily inhaled corticosteroids. Inhaled corticosteroids as rescue medication with albuterol might be an effective step- down strategy for children with well controlled, mild asthma because it is more effective at reducing exacerbations than is use of rescue albuterol alone. Use of daily inhaled corticosteroid treatment and related side-effects such as growth impairment can therefore be avoided."

Can help prevent and can be part of rescue whether used as preventer or not.

For the full abstract, click here.

The Lancet published online 15 February 2011 © 2011 Elsevier Limited
Use of beclomethasone dipropionate as rescue treatment for children with mild persistent asthma (TREXA): a randomised, double-blind, placebo-controlled trial. Fernando D Martinez, Vernon M Chinchilli, Wayne J Morgan. Correspondence to Fernando Martinez: [email protected]

Category: R. Respiratory. Keywords: beclamethasone dipropinate, rescue, treatment, children, mild, persistent, asthma, randomised, double-blind, placebo-controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 25 February 2011

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