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Do current treatment protocols adequately prevent airway remodeling in children with mild intermittent asthma?
Haim S Bibi1, David Feigenbaum, Mariana Hessen
1Pediatric Department and Pediatric Pulmonology Clinic, Barzilai Medical Center, Ashkelon, The Faculty of Health Sciences, Ben Gurion University of the Negev, Ashkelon 78306, Israel. haim_76407@yahoo.com
Insights
Regular inhaled steroid therapy helps prevent airway remodeling in children with mild asthma. Untreated children showed increased airway remodeling, highlighting the importance of early intervention and regular lung function testing.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Management
Background:
- Asthma management guidelines emphasize targeting airway remodeling and achieving normal lung function.
- Airway remodeling is a key concern in long-term asthma control.
Purpose of the Study:
- To investigate the impact of inhaled steroid therapy on airway remodeling in children with asthma.
- To assess the effect of inhaled corticosteroids on achieving normal lung function over a 5-year period.
Main Methods:
- A 5-year longitudinal study comparing two groups of asthmatic children.
- Group I received regular inhaled steroids; Group II (mild intermittent asthma) used bronchodilators as needed.
- Regular spirometry (pre- and post-bronchodilator) and physician examinations were conducted.
Main Results:
- The incidence of airway remodeling, indicated by low FEV1/FVC post-bronchodilator, significantly increased in the untreated group.
- In the treated group, the FEV1/FVC ratio decreased from 35% to 20.9% (P<0.009%).
- The proportion of untreated children with low FEV1/FVC increased from 10% to 28% over the study.
Conclusions:
- Children with mild asthma not on regular inhaled steroids face a higher risk of airway remodeling.
- Regular pulmonary function testing is recommended for children with mild intermittent asthma.
- Initiation of inhaled corticosteroid therapy is advised if FEV1/FVC ratio deteriorates.
Background:
Asthma treatment per Global Initiative for Asthma (GINA) guidelines targets airway remodeling and achievement of normal lung function.
Objective:
To study inhaled steroid therapy on airway remodeling and achievement of normal lung function. SUBJECTS AND SET UP: Asthmatic patients were followed over 5 years . The children were divided into two groups. Group I (148 children-treated group) consisted of all the children using inhaled steroids on a regular basis and group II (50 children-untreated group) included patients with mild intermittent asthma who did not use inhaled steroids and were treated with bronchodilators as needed. Detailed medication and compliance history were recorded and the children underwent regular pre- and post-bronchodilator spirometry and physician examination.
Results:
The incidence of airways remodeling as defined by the low FEV1/FVC post-bronchodilator was markedly increased over the 5-year period in the untreated group compared to the treated group. In the treated group the FEV1/FVC ratio post-bronchodilator decreased from 35% to 20.9% (P<0.009%) compared with the untreated group where the number of children with low FEV(1)/FVC post-bronchodilator increased from 10% to 28% by the end of the study period.
Conclusion:
Patients with mild asthma who do not receive regular inhaled steroids are at increased risk for airway remodeling. Therefore, we recommend that children with mild intermittent asthma undergo regular pulmonary function testing and that if any deterioration is detected in the FEV1/FVC ratio post-bronchodilators; preventative inhaled corticosteroid therapy be initiated.
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