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Pilot study: The effect of reducing treatment on exercise induced bronchoconstriction
E T G Kersten1, J M M Driessen, J C van Leeuwen
1Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands. elinkersten@gmail.com
Pediatric Pulmonology
|July 3, 2010
Summary
Reducing long-acting beta2-agonist (LABA) in children with stable asthma significantly decreased exercise-induced bronchoconstriction (EIB). In most cases, stopping LABA therapy abolished EIB, showing a potential for medication step-down.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Asthma management requires adjusting therapy based on control levels.
- Evidence for optimal timing and methods of asthma medication reduction is limited.
- Investigating the impact of reducing inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) therapy is crucial.
Purpose of the Study:
- To assess the effect of discontinuing long-acting beta2-agonist (LABA) on exercise-induced bronchoconstriction (EIB) in children with stable asthma.
- To evaluate if reducing ICS/LABA to ICS monotherapy impacts EIB.
- To hypothesize that EIB will not worsen after LABA cessation.
Main Methods:
- Pilot study involving 19 children (8-16 years) with stable asthma on ICS/LABA therapy.
- Open-label design with medication reduction to ICS monotherapy.
- Exercise challenge performed at baseline and 3 weeks post-reduction, analyzing forced expiratory volume in 1 second (FEV1) via spirometry.
Main Results:
- Maximum percent fall in FEV1 was significantly lower after 3 weeks of ICS monotherapy (P=0.03).
- In children with pre-existing EIB (n=8), the maximum FEV1 fall significantly decreased post-reduction (P<0.01).
- Six of these children no longer exhibited EIB (FEV1 fall <15%) after LABA cessation.
Conclusions:
- Cessation of LABA in children with stable asthma on ICS/LABA therapy can reduce EIB.
- In a majority of cases, stopping LABA therapy effectively abolishes EIB.
- This suggests a potential strategy for stepping down asthma medication in pediatric patients.
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