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May 10, 2006 -- For young kids at high risk of asthmaasthma, inhaled corticosteroids may ease asthma-like symptoms. But those benefits don't last after steroids are stopped, a new study shows.
The study appears in The New England Journal of Medicine. It included 285 kids who were about 3 years old when the three-year study started.
All of the kids were at high risk for asthma. They had had at least four wheezingwheezing episodes, with at least one of those episodes diagnosed by a doctor. They also had at least one or two other asthma risk factors, such as doctor-diagnosed atopic dermatitisdermatitis (eczemaeczema) or parental history of asthma.
The kids may have also had allergiesallergies, but not any other serious health problems. More than half of the kids were white (53%), while 12% were black, 20% were Hispanic, and about 15% were from other racial or ethnic groups.
Two Years of Treatment
The researchers included Theresa Guilbert, MD, of the Arizona Respiratory Center at the University of Arizona in Tucson. They randomly assigned the kids to two groups.
For two years, one group of kids used two daily doses of the inhaled corticosteroid Flovent. The other group got a placebo treatment that lacked any drug.
Afterward, the researchers stopped the daily inhaled Flovent and followed the kids for an extra year of observation. Throughout the study, the researchers interviewed the kids' parents about the children's asthma-like symptoms (coughing and wheezing). The interviews covered the kids' symptoms during the previous two weeks.
Children in both groups were treated as needed, if problems developed.
Fewer Symptoms
During the two-year treatment period, children that used Flovent had a greater proportion of days without asthmaasthma-like symptoms than kids in the placebo group.
Compared with the placebo group, the Flovent group also had a lower rate of worsening asthma symptoms that required further steroid treatment (such as steroid pills), the study also shows.
But those benefits didn't last into the observation year when none of the kids used daily Flovent.
"Clinical improvement was observed while the children were treated with inhaled corticosteroid but disappeared after treatment had been discontinued," write the researchers.
"Our data suggest that inhaled corticosteroids have little therapeutic effect on the processes that determine the progression of the disease from its initial, intermittent stages to a more chronic form, as described in the epidemiology literature," Guilbert and colleagues add.
Height Difference?
During the two-year treatment period, all of the kids grew taller. But there was a slight difference in height gain between the two groups.
The average height increase after 24 months of treatment was about four-tenths of an inch (1.1 centimeters) less for kids in the Flovent group, compared with the placebo group.
By the end of the observation year, the groups' difference in average height increase had narrowed to less than three-tenths of an inch (0.7 centimeters).
"It remains to be determined whether height will become similar in the two groups as the cohort matures, in a manner similar to that observed in older children," Guilbert's team writes.
In the journal, Guilbert and several of the other researchers report ties to various drug companies, including GlaxoSmithKline, which supplied the study's Flovent and placebo. GlaxoSmithKline is also a WebMD sponsor. The study was funded by grants from the National Heart, Lung, and Blood Institute, a branch of the National Institutes of Health.
Second Opinion
The journal also contains an editorial by Diane Gold, MD, MPH, and Anne Fuhlbrigge, MD. They work at Harvard Medical School and Boston's Brigham and Women's Hospital.
Gold and Fuhlbrigge write that "the study by Guilbert et al. strengthens the evidence that treatment with inhaled corticosteroids in early life does not alter the natural history of asthma."
However, the editorialists also note that Guilbert's study "offers strong evidence supporting the use of twice-daily inhaled corticosteroids" to control asthma-like symptoms in certain high-risk children.
SOURCES: Guilbert, T. The New England Journal of Medicine, May 11, 2006; vol 354: pp 1985-1997. Gold, D. The New England Journal of Medicine, May 11, 2006; vol 354: pp 2058-2060. News release, National Heart, Lung, and Blood Institute, National Institutes of Health.