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Inhaled Steroids Best First Asthma Therapy For Children

Inhaled steroids should be first-line treatment for school-aged children with asthma.

Low dose steroids will achieve the best combination of efficacy and safety in children, Finnish researchers suggest in a pilot study evaluating efficacy and safety of different asthma modalities.

Seventy-five children aged from 5.5 to 14.7 years, mean age 9.5 years, participated in the study. Thirty children started with budesonide (BUD) at 800 µg per day for two months and 400 µg/d thereafter. Another 30 children began with fluticasone propionate (FP) at 500 µg/d for two months, followed by 200 µg/d. A third group of 15 children started with cromones (CROM).

The investigators, from Kuopio University Hospital, assessed treatment efficacy by measuring forced expiratory volume in one second (FEV₁) and evaluating children's use of bronchodilators. Side effects were measured by tracking the children's growth and through low-dose adrenocorticotropic (ACTH) testing.

At four months, FEV₁ in children in the BUD group had improved by a mean of 8.2 percent; FEV₁ improved by a mean of 5.4 percent in the FP group.

Use of bronchodilators had decreased to one dose/week from five doses/week in the BUD group and to one dose/week from three doses/week in the FP group.

There were no FEV₁ or bronchodilator use changes in the CROM group.

Researchers estimate that to prevent one treatment failure in the CROM group, between three and five children would need to move to treatment with steroids.
Pediatric Allergy and Immunology, 2002; 13: 24-30. "Efficacy and safety of inhaled steroid and cromone treatment in school-age children: A randomized pragmatic pilot study"

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