PEDIATRICS Vol. 123 No. 1 January 2009, pp. 353-366 (doi:10.1542/peds.2007-3273)
REVIEW ARTICLE |
Inhaled Corticosteroids and Asthma Control in Children: Assessing Impairment and Risk
Executive Care Center for Asthma, Allergy, and Respiratory Diseases, Geffen School of Medicine at UCLA, Los Angeles, California
OBJECTIVE. To review the use of inhaled corticosteroids on asthma control in children by using the new therapeutic paradigm outlined in the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
METHODS. A systematic review of the literature was performed by using the Medline and Embase databases (January 1996 to October 2007).
RESULTS. A total of 18 placebo-controlled, clinical trials in >8000 children (aged 0–17 years) with asthma met the criteria for evaluating monotherapy with inhaled corticosteroids: 13 double-blind studies of inhaled corticosteroids versus placebo and 5 controlled studies that compared inhaled corticosteroids to a nonsteroid antiinflammatory agent. The findings can be summarized as follows: (1) Compared with placebo, inhaled corticosteroid treatment was associated with reductions in both the impairment and risk domains. (2) Improvements in impairment and risk observed with inhaled corticosteroids were generally greater than those observed with nonsteroid antiinflammatory comparator medications. (3) Inhaled corticosteroids were well tolerated. (4) Small reductions in growth rates were evident when compared with placebo and/or comparator nonsteroid antiinflammatory medication use in the long-term (>1-year) studies, but when measured, the reductions diminished with time.
CONCLUSIONS. Treatment with inhaled corticosteroids improves the asthma-control domains of impairment and risk in children. Differences in study protocols make detailed comparisons difficult. Specific needs for additional trials include (1) more studies using appropriate indicators for impairment (eg, rescue-medication use; symptoms scores; asthma/episode-free days) and risk (eg, forced expiratory volume in 1 second in children who can perform spirometry; exacerbations requiring oral corticosteroids; urgent care usage) and (2) more studies evaluating adolescents; the majority of the data reported were for children up to the age of 12 years, and data for adolescents are often lost (either grouped with adults [eg, studies in patients 
12 years old] or not included [eg, studies of school-aged children 
12 years old]). Attention should be given to standardizing variables that will permit comparison of outcomes between trials.
Key Words: asthma control • childhood asthma • impairment • inhaled corticosteroid • pediatric asthma • persistent asthma • risk
Abbreviations: EPR—Expert Panel report • ED—emergency department • ICS—inhaled corticosteroid • mAPI—modified Asthma Predictive Index • OCS—oral corticosteroid • FDA—Food and Drug Administration • BIS—budesonide inhalation suspension • FP—fluticasone propionate • DPI—dry powder inhaler • BDP—beclomethasone dipropionate • AE—adverse event • CAMP—Childhood Asthma Management Program • NED—nedocromil sodium • SAB—short-acting bronchodilator • FEV1—forced expiratory volume in 1 second • bid—twice daily • qd—once daily • START—Steroid Treatment as Regular Therapy • prn—as needed • SARE—severe asthma-related event • LABA—long-acting bronchodilator
Accepted Apr 16, 2008.
Read all eLetters
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
eLetters:
