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Oral-steroid sparing effect of inhaled fluticasone propionate in children with steroid-dependent asthma
S Sheikh1, L J Goldsmith, N Eid
1Division of Pediatric Pulmonary Medicine, Department of Pediatrics;
Insights
Inhaled fluticasone propionate (FP) significantly reduced oral steroid dependence in children with severe asthma. Most children discontinued oral steroids, maintaining asthma control with inhaled FP, suggesting it may be a superior treatment option.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Pharmacology
Background:
- Steroid-dependent asthma in children poses significant management challenges.
- Oral corticosteroids, while effective, are associated with numerous adverse effects.
- Finding effective steroid-sparing agents is crucial for long-term asthma management in pediatric populations.
Purpose of the Study:
- To assess the oral steroid-sparing efficacy of inhaled fluticasone propionate (FP) in children with steroid-dependent asthma.
- To evaluate the impact of inhaled FP on asthma control and exacerbations.
- To compare the effectiveness of inhaled FP with oral steroids in managing severe pediatric asthma.
Main Methods:
- A treatment protocol study was conducted at a tertiary pediatric pulmonary care center.
- Eight children with severe persistent steroid-dependent asthma were enrolled.
- Inhaled FP (880 mug/day) was administered, with gradual reduction of oral steroid dosage over six months, followed by a dose reduction of inhaled FP.
Main Results:
- Within three months, mean oral steroid dose decreased from 38 mg to 2.5 mg, with six patients (66%) discontinuing oral steroids.
- Significant improvements were observed in emergency room visits, asthma exacerbations, hospital admissions, and school days lost (P<0.05).
- Pulmonary function tests (FEV(1) and FEF(25%-75%)) showed significant improvement while on inhaled FP compared to oral steroids (P<0.05).
Conclusions:
- High-dose inhaled fluticasone propionate (880 mug/day) demonstrates a significant oral steroid-sparing effect in children with severe asthma.
- Asthma control is maintained with a lower dose of inhaled FP after oral steroid tapering.
- Inhaled FP may offer superior asthma control compared to oral steroids in this pediatric population.
Objective:
To evaluate the oral steroid-sparing effect of inhaled fluticasone propionate (FP) in eight children with steroid-dependent asthma.
Design And Setting:
Treatment protocol study at a tertiary pulmonary care centre at a children's hospital.
Patients:
Eight children with severe persistent steroid dependent asthma (mean age 11.6 years [range 10 to 13 years], mean duration of asthma 8.37 years [range three to 11 years]) were enrolled in the study.
Measurements:
Inhaled FP 880 mug/day (two puffs of 220 mug/puff, two times a day) was added to the children's asthma treatment, and attempts were made to reduce the dose of oral steroids by 20% every two weeks over a six-month period. After this six-month period, in the patients responding to inhaled FP, the dose of inhaled FP was reduced to 440 mug/day (two puffs of 110 mug/puff, two times a day) for the next six months. The mean percentage predicted values for forced expiratory volume in 1 s (FEV(1)) and maximal mid-expiratory flow rate (FEF(25%-75%)) were compared during the first month, at two to six months, and at seven to 12 month intervals before and after starting FP. The number of asthma exacerbations, emergency room visits, hospital admissions and number of school days lost were also compared.
Results:
Within three months of starting inhaled FP, the mean alternate-day oral steroid dose decreased from 38 mg to 2.5 mg. In addition, six patients (66%) were able to discontinue the use of oral steroids. There was significant improvement in the number of mean emergency room visits per patient (P=0.016), mean asthma exacerbations per patient (P=0.016), mean hospital admissions per patient (P=0.016) and mean number of school days lost per patient (P=0.004) while patients were receiving high dose inhaled FP compared with oral steroids. There was no deterioration of any of the above mentioned parameters during the six month period when the dose of inhaled FP was reduced. The mean FEV(1) and FEF(25%-75%) during the two- to six-month and seven- to 12-month periods showed significant improvement, while the patients were receiving FP compared with oral steroids (P<0.05 for both parameters for both time periods).
Conclusions:
High dose inhaled FP 880 mug/day has an important oral steroid-sparing effect. After oral steroids are tapered, patients maintain adequate control of asthma with low dose inhaled FP. These findings suggest that FP may control asthma better than oral steroids.
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