Effect of Corticosteroids on Development of Asthma in Children
Guilbert TW, Morgan WJ, Zeiger RS, et al
N Engl J Med. 2006;354:1985-1997
This distinguished group of investigators studied a randomly selected group of 285 children, aged 2 or 3 years, who were determined to be at high risk of developing asthma. Their goal was to see whether treatment with fluticasone 88 mcg/day for 2 years would help prevent the development of asthma, as measured during a 1-year observation period following 2 years of treatment with an inhaled corticosteroid (ICS). The study's primary outcome was the number of episode-free days in those children who were treated with an ICS compared with those treated with a placebo.
The study found that those children who were treated with fluticasone for 2 years had significantly more episode-free days, fewer asthma exacerbations, and less use of supplementary asthma controller medications. There was a reduction in growth velocity in the group that was treated with ICS during the first year of the study, but the growth rate appeared to be the same in both the fluticasone and placebo groups during the second year of the study. A 0.7-cm difference in height remained between the active treatment and placebo groups at the end of the study, and it is not known whether the 2 groups would normalize given more time. The study authors pointed out that the growth results seen from this study differed from growth data with this drug in other studies. The study authors suggest that the method of drug delivery or the lack of a spacer device may explain the discrepancies.
The study concluded that treatment with ICS for 2 years in children at significant risk of developing asthma does not alter the natural course of asthma in young children. However, the burden of disease is significantly lessened in those taking ICS compared with those taking a placebo.
Guilbert TW, Morgan WJ, Zeiger RS, et al
N Engl J Med. 2006;354:1985-1997
This distinguished group of investigators studied a randomly selected group of 285 children, aged 2 or 3 years, who were determined to be at high risk of developing asthma. Their goal was to see whether treatment with fluticasone 88 mcg/day for 2 years would help prevent the development of asthma, as measured during a 1-year observation period following 2 years of treatment with an inhaled corticosteroid (ICS). The study's primary outcome was the number of episode-free days in those children who were treated with an ICS compared with those treated with a placebo.
The study found that those children who were treated with fluticasone for 2 years had significantly more episode-free days, fewer asthma exacerbations, and less use of supplementary asthma controller medications. There was a reduction in growth velocity in the group that was treated with ICS during the first year of the study, but the growth rate appeared to be the same in both the fluticasone and placebo groups during the second year of the study. A 0.7-cm difference in height remained between the active treatment and placebo groups at the end of the study, and it is not known whether the 2 groups would normalize given more time. The study authors pointed out that the growth results seen from this study differed from growth data with this drug in other studies. The study authors suggest that the method of drug delivery or the lack of a spacer device may explain the discrepancies.
The study concluded that treatment with ICS for 2 years in children at significant risk of developing asthma does not alter the natural course of asthma in young children. However, the burden of disease is significantly lessened in those taking ICS compared with those taking a placebo.