Long-term inhaled corticosteroids in preschool children at high risk for asthma

Area of Science:

• Pediatric Pulmonology
• Allergy and Immunology
• Clinical Pharmacology

Background:

• Asthma development in high-risk preschool children remains a significant clinical concern.
• The potential disease-modifying effects of early inhaled corticosteroid (ICS) intervention are not well-established.
• Investigating ICS in preschool children is crucial for understanding long-term asthma trajectories.

Purpose of the Study:

• To determine if two years of inhaled fluticasone propionate modifies subsequent asthma development in high-risk preschool children.
• To assess the impact of ICS on asthma symptoms, exacerbations, and lung function during and after treatment.

Main Methods:

• A randomized, placebo-controlled trial involving 285 preschool children (2-3 years) with a positive asthma predictive index.
• Participants received fluticasone propionate (88 mcg twice daily) or placebo for two years, followed by a one-year observation period without medication.
• The primary outcome was the proportion of episode-free days during the observation year.

Main Results:

• During the treatment period, ICS significantly reduced asthma symptoms, exacerbations, and controller medication use compared to placebo.
• However, ICS treatment was associated with a temporary reduction in growth velocity.
• During the one-year post-treatment observation, no significant differences in episode-free days, exacerbations, or lung function were observed between the ICS and placebo groups.

Conclusions:

• Two years of ICS therapy in high-risk preschool children did not alter asthma symptom development or lung function in the subsequent treatment-free year.
• These findings suggest that ICS therapy in this population does not confer a sustained disease-modifying effect after discontinuation.
• Further research may be needed to explore alternative or longer-term strategies for asthma prevention in high-risk children.