[Methotrexate for steroid-dependent asthmatic children and adolescents]

The administration of methotrexate as an antiinflammatory drug in asthma has been discussed and most of the studies were developed in adults. Its indication is restricted to steroid-dependent or steroid-resistant asthmatic patients.

This study evaluates the clinical and espirometric parameters of steroid-dependent asthmatic children, receiving methotrexate therapy.

Perennial steroid-dependent asthmatic patients (prednisone 30 or 40 mg/dia), without associated disease, were evaluated by means of clinical and spirometric parameters. A maintenance dose of 10 to 17.5 mg/ week of methotrexate was administered.

Six patients (3M;3F), aged 7 to 13 years old were included. There was improvement of clinical symptoms during the administration of methotrexate, in all patients, without significant change in the pulmonary function. During the use of methotrexate therapy three patients presented adverse reactions: leukopenia (1/3), vomiting (1/3) or Herpes zoster (1/3). The dose of prednisone was reduced in all patients, with total exclusion of prednisone in 3. Afterwards, there was a worsening of asthmatic symptoms in all patients, with reintroduction of corticosteroids.

Methotrexate represents an alternative therapy for steroid-dependent asthmatics, and it may help to control symptoms of asthma and steroids use. Nevertheless, double-blind studies should be developed in children. Adverse effects must be considered before its indication, restricting its use to specialized centers.