Strunk RC, Sternberg AL, Szefler SJ, et al. J Pediatr. 2009;154(5):682–687
PURPOSE OF THE STUDY. To determine whether long-term, continuous use of inhaled antiinflammatory medications affects asthma outcomes in children with mild-to-moderate asthma after use is discontinued.
STUDY POPULATION. A total of 941 children, 5 to 12 years of age, who had previously participated in the Childhood Asthma Management Program (CAMP).
METHODS. During the CAMP trial, subjects received treatment with budesonide, nedocromil, or placebo for 4.3 years. During the posttrial period, asthma management was provided by primary care physicians according to National Asthma Education and Prevention Program guidelines. Posttrial evaluations included spirometry, methacholine challenge, measurements of height, weight, and bone density, the Child Behavior Checklist, and the Pediatric Asthma Quality of Life Questionnaire.
RESULTS. Treatment for asthma was similar for all 3 groups. The budesonide group had 29% fewer prednisone courses (P = .05) and 36% fewer urgent care visits (P = .05), compared with the placebo group, but the rates of these events were low in all groups. The statistically significantly decreased height in the budesonide group, relative to the placebo group, at the end of the CAMP trial (1.1 cm; P = .005) persisted, with a decrease of 0.9 cm (P = .01) at the end of the posttrial follow-up period. This height decrease was observed in girls but not boys. No significant differences between the groups were observed in mean percentage of time receiving inhaled corticosteroid, mean percentage of time using no medications, end-of-trial percentage of predicted forced expiratory volume in 1 second and percentage of predicted forced vital capacity, bronchodilator reversibility, methacholine responsiveness, rate of fractures, sexual maturation, or any of the psychological or asthma-specific quality of life measures examined.
CONCLUSIONS. During the posttrial follow-up period, asthma morbidity and medication use were not appreciably affected by earlier long-term use of budesonide or nedocromil. The reductions in prednisone course and urgent care visits seen in the budesonide group do not seem relevant, on the basis of the overall rates of these events in all groups.
REVIEWER COMMENTS. Inhaled corticosteroids are safe and effective for long-term control of asthma, but this study shows that continued benefit requires ongoing use. We must continue to consider factors such as symptoms, spirometry findings, and biochemical markers and to use our clinical judgment to determine which children will benefit from continued treatment. It is hoped that future phenotype and genotype studies will shed more light on this issue.
- Copyright © 2009 by the American Academy of Pediatrics