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Lung function in school-aged asthmatic children with inhaled cromoglycate, nedocromil and corticosteroid therapy
K Korhonen1, M Korppi, S T Remes
1Dept of Paediatrics, Kuopio University Hospital, Finland.
Insights
Most children with asthma can be effectively treated with cromones, a type of asthma maintenance therapy. Inhaled steroids are best reserved for those whose asthma is not controlled by cromones.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Respiratory Medicine
Background:
- Current asthma treatment policies vary.
- Cromones and inhaled steroids are common maintenance therapies for pediatric asthma.
- International consensus guidelines exist for asthma management.
Purpose of the Study:
- To evaluate a local treatment policy for pediatric asthma.
- To assess the efficacy of cromones versus inhaled steroids in children with asthma.
- To align local practice with international asthma management consensus.
Main Methods:
- Retrospective collection of lung function data from 195 school-aged asthmatic patients.
- Analysis of peak expiratory flow (PEF), dynamic spirometry, and bronchodilation tests.
- Categorization of patients based on maintenance therapy: cromoglycate, nedocromil, inhaled steroids, or combination therapy.
Main Results:
- Lung function was generally good across all treatment groups, with no significant pre- or post-bronchodilator differences.
- Decreased lung function (PEF, FEV1, MMEF) was observed in a minority of patients (20%), primarily MMEF.
- Bronchodilation tests were positive in 17% of cases, indicating reversible airway obstruction.
Conclusions:
- Over 70% of pediatric asthma cases can be managed with a stepwise approach using cromones.
- Inhaled steroids should be reserved for patients not adequately controlled by cromones.
- Regular lung function testing, including post-bronchodilator measurements, is crucial for monitoring asthma maintenance therapy.
Abstract:
Two-thirds of the children with asthma in our area use cromones and only one-third steroids as the maintenance therapy. This study aimed to evaluate our treatment policy based on the international consensus. Peak expiratory flow (PEF), dynamic spirometry and bronchodilation test results were therefore collected in 195 school-aged patients who visited our outpatient clinic in 1995. Sixty-four children (33%) used cromoglycate, 86 (44%) nedocromil and 45 (23%) inhaled steroids. Twenty-five (12%) needed combination therapy, mainly with salmeterol. Lung function results were good, and there were no significant differences between the therapeutic groups irrespective of whether pre- or postbronchodilator values were considered. PEF was decreased in eight (4%), forced expiratory volume in one second (FEVI) in four (2%) and maximum mid-expiratory flow (MMEF) in 33 (17%) patients. At least one result was decreased in 39 (20%) cases, in most cases (77%) MMEF alone. Significant rises after salbutamol inhalations were observed in 17 (9%) in PEF, in two (1%) in FEV1 and 20 (10%) in MMEF values. Thus, the bronchodilation test was positive in 33 (17%) cases, and in 22 (11%) cases it was the only sign of bronchial obstruction. Over 70% of the children with asthma can be treated with cromones by a stepwise treatment modality. Inhaled steroids can be restricted to those not controllable by cromones. Lung function tests, including postbronchodilator values, should be part of the follow-up of continuous maintenance medication for asthma.