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Daily versus as-needed inhaled corticosteroid for mild persistent asthma (The Helsinki early intervention childhood asthma study).

Turpeinen M, Nikander K, Pelkonen AS, Syvänen P, Sorva R, Raitio H, Malmberg P, Juntunen-Backman K, Haahtela T - Arch. Dis. Child. (2007)

Bottom Line: During months 7-18, patients receiving continuous budesonide treatment had significantly fewer exacerbations (mean 0.97), compared with 1.69 in group 2 and 1.58 in group 3.The latter was associated with catch-up growth.Some children do not seem to need continuous ICS treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland. markku.t.turpeinen@hus.fi

ABSTRACT

Objective: To compare the effect of inhaled budesonide given daily or as-needed on mild persistent childhood asthma. Patients, design and

Interventions: 176 children aged 5-10 years with newly detected asthma were randomly assigned to three treatment groups: (1) continuous budesonide (400 microg twice daily for 1 month, 200 microg twice daily for months 2-6, 100 microg twice daily for months 7-18); (2) budesonide, identical treatment to group 1 during months 1-6, then budesonide for exacerbations as needed for months 7-18; and (3) disodium cromoglycate (DSCG) 10 mg three times daily for months 1-18. Exacerbations were treated with budesonide 400 microg twice daily for 2 weeks.

Main outcome measures: Lung function, the number of exacerbations and growth.

Results: Compared with DSCG the initial regular budesonide treatment resulted in a significantly improved lung function, fewer exacerbations and a small but significant decline in growth velocity. After 18 months, however, the lung function improvements did not differ between the groups. During months 7-18, patients receiving continuous budesonide treatment had significantly fewer exacerbations (mean 0.97), compared with 1.69 in group 2 and 1.58 in group 3. The number of asthma-free days did not differ between regular and intermittent budesonide treatment. Growth velocity was normalised during continuous low-dose budesonide and budesonide therapy given as needed. The latter was associated with catch-up growth.

Conclusions: Regular use of budesonide afforded better asthma control but had a more systemic effect than did use of budesonide as needed. The dose of ICS could be reduced as soon as asthma is controlled. Some children do not seem to need continuous ICS treatment.

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Related in: MedlinePlus

Mean change in standing height (SDS) over the 18-month study period for the continuous budesonide (◊, n = 50), budesonide/placebo (□, n = 45) and disodium cromoglycate (DSCG) (Δ, n = 43) treatment groups. 1–6 months, both budesonide groups versus DSCG, p<0.001; 7–18 months, continuous budesonide group versus budesonide/placebo group, p = 0.016. Note the fast height velocity during months 7–18 in the budesonide/placebo group.
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adc-93-08-0654-f04: Mean change in standing height (SDS) over the 18-month study period for the continuous budesonide (◊, n = 50), budesonide/placebo (□, n = 45) and disodium cromoglycate (DSCG) (Δ, n = 43) treatment groups. 1–6 months, both budesonide groups versus DSCG, p<0.001; 7–18 months, continuous budesonide group versus budesonide/placebo group, p = 0.016. Note the fast height velocity during months 7–18 in the budesonide/placebo group.

Mentions: From baseline to 6 months, the mean standing–height velocity in the budesonide groups was 2 cm/year slower than in the DSCG group (p<0.001). From 7 to 18 months, height velocity increased in both budesonide groups, with the mean height velocity being greater for the budesonide/placebo group (ie, during placebo) than the continuous budesonide group (6.2 versus 5.6 cm; p = 0.016). After 18 months of treatment, children receiving DSCG had grown, on average, 1.0 cm more than children in the continuous budesonide group (8.8 versus 7.8 cm; p = 0.008) and 0.6 cm more than children in the budesonide/placebo group (ie, during placebo) (8.8 versus 8.2 cm; p = 0.048). Development of standing height is presented as standard deviation scores (SDS) in fig 4. No significant differences in body mass index were observed between treatment groups at any time point.


Daily versus as-needed inhaled corticosteroid for mild persistent asthma (The Helsinki early intervention childhood asthma study).

Turpeinen M, Nikander K, Pelkonen AS, Syvänen P, Sorva R, Raitio H, Malmberg P, Juntunen-Backman K, Haahtela T - Arch. Dis. Child. (2007)

Mean change in standing height (SDS) over the 18-month study period for the continuous budesonide (◊, n = 50), budesonide/placebo (□, n = 45) and disodium cromoglycate (DSCG) (Δ, n = 43) treatment groups. 1–6 months, both budesonide groups versus DSCG, p<0.001; 7–18 months, continuous budesonide group versus budesonide/placebo group, p = 0.016. Note the fast height velocity during months 7–18 in the budesonide/placebo group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2532957&req=5

adc-93-08-0654-f04: Mean change in standing height (SDS) over the 18-month study period for the continuous budesonide (◊, n = 50), budesonide/placebo (□, n = 45) and disodium cromoglycate (DSCG) (Δ, n = 43) treatment groups. 1–6 months, both budesonide groups versus DSCG, p<0.001; 7–18 months, continuous budesonide group versus budesonide/placebo group, p = 0.016. Note the fast height velocity during months 7–18 in the budesonide/placebo group.
Mentions: From baseline to 6 months, the mean standing–height velocity in the budesonide groups was 2 cm/year slower than in the DSCG group (p<0.001). From 7 to 18 months, height velocity increased in both budesonide groups, with the mean height velocity being greater for the budesonide/placebo group (ie, during placebo) than the continuous budesonide group (6.2 versus 5.6 cm; p = 0.016). After 18 months of treatment, children receiving DSCG had grown, on average, 1.0 cm more than children in the continuous budesonide group (8.8 versus 7.8 cm; p = 0.008) and 0.6 cm more than children in the budesonide/placebo group (ie, during placebo) (8.8 versus 8.2 cm; p = 0.048). Development of standing height is presented as standard deviation scores (SDS) in fig 4. No significant differences in body mass index were observed between treatment groups at any time point.

Bottom Line: During months 7-18, patients receiving continuous budesonide treatment had significantly fewer exacerbations (mean 0.97), compared with 1.69 in group 2 and 1.58 in group 3.The latter was associated with catch-up growth.Some children do not seem to need continuous ICS treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland. markku.t.turpeinen@hus.fi

ABSTRACT

Objective: To compare the effect of inhaled budesonide given daily or as-needed on mild persistent childhood asthma. Patients, design and

Interventions: 176 children aged 5-10 years with newly detected asthma were randomly assigned to three treatment groups: (1) continuous budesonide (400 microg twice daily for 1 month, 200 microg twice daily for months 2-6, 100 microg twice daily for months 7-18); (2) budesonide, identical treatment to group 1 during months 1-6, then budesonide for exacerbations as needed for months 7-18; and (3) disodium cromoglycate (DSCG) 10 mg three times daily for months 1-18. Exacerbations were treated with budesonide 400 microg twice daily for 2 weeks.

Main outcome measures: Lung function, the number of exacerbations and growth.

Results: Compared with DSCG the initial regular budesonide treatment resulted in a significantly improved lung function, fewer exacerbations and a small but significant decline in growth velocity. After 18 months, however, the lung function improvements did not differ between the groups. During months 7-18, patients receiving continuous budesonide treatment had significantly fewer exacerbations (mean 0.97), compared with 1.69 in group 2 and 1.58 in group 3. The number of asthma-free days did not differ between regular and intermittent budesonide treatment. Growth velocity was normalised during continuous low-dose budesonide and budesonide therapy given as needed. The latter was associated with catch-up growth.

Conclusions: Regular use of budesonide afforded better asthma control but had a more systemic effect than did use of budesonide as needed. The dose of ICS could be reduced as soon as asthma is controlled. Some children do not seem to need continuous ICS treatment.

Show MeSH
Related in: MedlinePlus