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Ketotifen versus inhaled budesonide for controlling childhood asthma
Pavana Tantichaiyakul1, Aroonwan Preutthipan
1Division of Pediatrics, Banpong Hospital, Ratchaburi, Thailand. pavana_tanti@hotmail.com
Insights
Ketotifen and inhaled budesonide effectively prevent childhood asthma exacerbations. Both treatments were safe and well-tolerated, offering comparable reductions in emergency room visits for pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Allergy and Immunology
Background:
- International asthma guidelines recommend inhaled corticosteroids (ICS) as first-line controller therapy for children.
- In resource-limited settings, ketotifen, an inexpensive antihistamine and anti-allergic medication, is frequently used for asthma prophylaxis.
- This study addresses the need for effective and accessible asthma management options in developing regions.
Purpose of the Study:
- To compare the efficacy and safety of oral ketotifen versus inhaled budesonide in managing asthma in children.
- To evaluate treatment outcomes in pediatric patients aged 8 months to 14 years at Banpong Hospital, Thailand.
Main Methods:
- A randomized controlled trial involving 30 children (16 ketotifen, 14 budesonide) with recurrent wheezing episodes.
- Children received either oral ketotifen (0.5-1 mg twice daily) or inhaled budesonide (200 mcg twice daily) for 26 weeks.
- Daily symptom diaries and nebulizer use were recorded by caregivers.
Main Results:
- Both ketotifen and budesonide significantly reduced emergency room (ER) visits for asthma exacerbations (p < 0.005).
- The reduction in ER visits was comparable between the two groups (p = 0.16).
- Ketotifen also reduced hospital stay days (p < 0.05), while budesonide increased symptom-free days (p < 0.05). Both were well-tolerated, with ketotifen associated with weight gain and no significant difference in height growth.
Conclusions:
- Ketotifen and inhaled budesonide are effective and safe for preventing pediatric asthma exacerbations.
- These findings support the use of both medications, particularly ketotifen, in resource-limited settings for childhood asthma management.
- Both treatments demonstrate good tolerability and safety profiles in pediatric asthma patients.
Background:
International asthma guideline recommends inhaled corticosteroids therapy for children of all ages as the first controller. However, in some less developed parts of the world, ketotifen, an old inexpensive medicine with antihistaminic and anti-allergic reactions, has been found to be the most favored prophylactic agents.
Objective:
To compare the efficacy and safety of ketotifen and inhaled budesonide in asthmatic children aged 8 months to 14 years at Banpong Hospital, located 80 km south from Bangkok.
Material And Method:
Children who had been admitted with acute asthmatic attack in 2008 at Banpong Hospital and had > 3 episodes of wheeze with good response to nebulized bronchodilators were randomized into two groups. Ketotifen group (n = 16) were given oral ketotifen 0.5 mg or 1 mg twice daily depending on age. Budesonide group (n = 14) were given as inhaled budesonide 200 microg (MDI) twice daily. Caregivers recorded children's asthmatic symptoms and nebulized treatments in diaries every day. The enrolled children received these two treatment regimens and were followed up for 26 weeks.
Results:
Number of ER visits decreased significantly after both treatments (p < 0.005). The percentage of children with reduction in ER visits was comparable between ketotifen and budesonide (p = 0.16). Ketotifen group also demonstrated a reduction in days of hospital stay (p < 0.05). Budesonide treatment resulted in more symptom-free days (p < 0.05). Both medications were well tolerated and safe. The only demonstrated side effect of ketotifen was weight gain. The growth rate in height for both groups did not differ.
Conclusion:
Both ketotifen and inhaled budesonide are effective, safe, and well-tolerated in the prevention of asthma exacerbation in children particularly in the country with limited resource.
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