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Inhaled corticosteroids and asthma control in children: assessing impairment and risk
1Executive Care Center for Asthma, Allergy, and Respiratory Diseases, Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. grachelefsky@mednet.ucla.edu
Insights
Inhaled corticosteroids effectively improve asthma control in children, reducing impairment and risk. While generally safe, long-term studies show minor, diminishing growth rate reductions.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Clinical Trial Analysis
Background:
- Asthma management in children requires effective therapeutic strategies.
- The Expert Panel Report 3 (EPR-3) provides updated guidelines for asthma diagnosis and management.
- Inhaled corticosteroids (ICS) are a cornerstone of asthma therapy.
Purpose of the Study:
- To review the efficacy of inhaled corticosteroids (ICS) for asthma control in pediatric populations.
- To evaluate ICS use within the framework of the EPR-3 guidelines.
- To assess ICS impact on both impairment and risk domains of asthma control.
Main Methods:
- Systematic literature review of Medline and Embase databases (January 1996 - October 2007).
- Inclusion of 18 placebo-controlled trials involving over 8000 children (0-17 years) with asthma.
- Analysis of 13 double-blind ICS vs. placebo studies and 5 ICS vs. non-steroid anti-inflammatory agent studies.
Main Results:
- Inhaled corticosteroids significantly reduced asthma impairment and risk compared to placebo.
- ICS demonstrated greater improvements in impairment and risk than non-steroid comparator medications.
- ICS were well-tolerated, with minor, transient growth reductions observed in long-term studies.
Conclusions:
- Inhaled corticosteroids are effective in improving asthma control domains (impairment and risk) in children.
- Further research is needed to standardize outcome measures and evaluate adolescents specifically.
- Additional trials should focus on precise indicators for impairment and risk, and include adolescent populations.
Objective:
To review the use of inhaled corticosteroids on asthma control in children by using the new therapeutic paradigm outlined in the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma.
Methods:
A systematic review of the literature was performed by using the Medline and Embase databases (January 1996 to October 2007).
Results:
A total of 18 placebo-controlled, clinical trials in >8000 children (aged 0-17 years) with asthma met the criteria for evaluating monotherapy with inhaled corticosteroids: 13 double-blind studies of inhaled corticosteroids versus placebo and 5 controlled studies that compared inhaled corticosteroids to a nonsteroid antiinflammatory agent. The findings can be summarized as follows: (1) Compared with placebo, inhaled corticosteroid treatment was associated with reductions in both the impairment and risk domains. (2) Improvements in impairment and risk observed with inhaled corticosteroids were generally greater than those observed with nonsteroid antiinflammatory comparator medications. (3) Inhaled corticosteroids were well tolerated. (4) Small reductions in growth rates were evident when compared with placebo and/or comparator nonsteroid antiinflammatory medication use in the long-term (>1-year) studies, but when measured, the reductions diminished with time.
Conclusions:
Treatment with inhaled corticosteroids improves the asthma-control domains of impairment and risk in children. Differences in study protocols make detailed comparisons difficult. Specific needs for additional trials include (1) more studies using appropriate indicators for impairment (eg, rescue-medication use; symptoms scores; asthma/episode-free days) and risk (eg, forced expiratory volume in 1 second in children who can perform spirometry; exacerbations requiring oral corticosteroids; urgent care usage) and (2) more studies evaluating adolescents; the majority of the data reported were for children up to the age of 12 years, and data for adolescents are often lost (either grouped with adults [eg, studies in patients > or =12 years old] or not included [eg, studies of school-aged children < or =12 years old]). Attention should be given to standardizing variables that will permit comparison of outcomes between trials.
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