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Published on: April 13, 2010
Inhaled corticosteroids and growth of airway function in asthmatic children
P J F M Merkus1, W van Pelt, J C van Houwelingen
1Division of Respiratory Medicine, Dept of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands. p.j.f.m.merkus@erasmusmc.nl
Insights
Inhaled corticosteroids (ICS) promote normal airway function development in children with asthma. While ICS improve central and intermediate airways, peripheral airway function remains reduced, suggesting potential remodelling or undertreatment.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Pathophysiology
Background:
- Airway inflammation and remodelling are key to asthma's development.
- Childhood asthma can impact lung function growth, potentially reversible with treatment.
- The study investigates asthma's effect on airway function growth and ICS efficacy.
Purpose of the Study:
- To assess if asthma affects airway function growth relative to airspaces in children.
- To determine if inhaled corticosteroids (ICS) can reverse these effects.
- To compare airway growth patterns in asthmatic children with healthy controls.
Main Methods:
- Longitudinal study of 54 asthmatic children (7-16 years) over 3 years.
- Randomized, double-blind trial comparing beta2-agonist (BA)+ICS vs. BA+placebo (PL).
- Lung function measured every 4 months, assessing central, intermediate, and peripheral airways pre- and post-bronchodilation.
Main Results:
- BA+PL group showed persistently reduced airway patency compared to healthy children.
- BA+ICS group demonstrated significant improvement in central and intermediate airways to near-normal levels.
- Peripheral airway patency remained reduced in the BA+ICS group, though improved versus BA+PL.
Conclusions:
- Anti-inflammatory treatment with ICS supports normal functional development of central and intermediate airways in asthmatic children.
- Reduced peripheral airway patency may indicate persistent airway remodelling or inadequate anti-inflammatory therapy.
- ICS treatment significantly improves symptoms and airway calibre in pediatric asthma.
Abstract:
Airway inflammation and remodelling play an important role in the pathophysiology of asthma. Remodelling may affect childhood lung function, and this process may be reversed by anti-inflammatory treatment. The current study assessed longitudinally whether asthma affects growth of airway function relative to airspaces, and if so whether this is redressed by inhaled corticosteroids (ICS). Every 4 months for up to 3 yrs, lung function was assessed in 54 asthmatic children (initial age 7-16 yrs), who inhaled 0.2 mg salbutamol t.i.d. and 0.2 mg budesonide t.i.d. (beta2-agonist (BA)+ICS), or placebo (PL) t.i.d. (BA+PL) in a randomised, double-blind design. Measurements were carried out before and after maximal bronchodilation. Airway growth was assessed from the change of forced expiratory volume in one second and of maximal expiratory flows (at 60% and 40% of total lung capacity (TLC) remaining in the lung) relative to TLC, as measures of more central, intermediate and more peripheral airways. Growth patterns were compared with the longitudinal findings in 376 healthy children. Airway patency after maximal bronchodilation in patients on BA+PL remained reduced compared to healthy subjects, whereas in patients on BA+ICS a marked improvement was observed to subnormal. No differences between patients and controls could be demonstrated for growth patterns of central and intermediate airway function. Compliance with BA+ICS was 75% of the prescribed dose, resulting in significant, sustained improvement of symptoms and postbronchodilator calibre of central and intermediate airways to subnormal within 2 months, but postbronchodilator small airway patency remained reduced, though improved compared to patients on BA+PL. Anti-inflammatory treatment of asthmatic children is associated with normal functional development of central and intermediate airways. The persistently reduced postbronchodilator patency of peripheral airways may reflect remodelling, or insufficient anti-inflammatory treatment.
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