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Dose response of inhaled corticosteroids in children with persistent asthma: a systematic review

Linjie Zhang1, Inge Axelsson, Mei Chung

  • 1Maternal and Child Health Unit, Faculty of Medicine, Federal University of Rio Grande, Rua Visconde de Paranagua 102, Centro, Rio Grande-RS, Brazil. zhanglinjie63@yahoo.com.br

Pediatrics
|December 8, 2010
PubMed

Insights

Moderate doses of inhaled corticosteroids (ICSs) offer minimal benefit over low doses for children with mild-to-moderate persistent asthma. Further research is needed to fully understand ICS dose-response in childhood asthma.

Area of Science:

  • Pediatric Pulmonology
  • Pharmacology
  • Clinical Trials

Background:

  • Persistent asthma is a common chronic respiratory condition in children.
  • Inhaled corticosteroids (ICSs) are the cornerstone of asthma management.
  • Understanding the optimal ICS dosage is crucial for effective treatment and minimizing adverse effects.

Purpose of the Study:

  • To evaluate the dose-response relationship of inhaled corticosteroids (ICSs) in children with persistent asthma.
  • To compare the benefits and harms of different ICS doses.
  • To determine if higher ICS doses provide clinically significant advantages.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Included children aged 3-18 years with persistent asthma.
  • Compared low (≤200 μg/day) versus moderate (300-400 μg/day) beclomethasone-equivalent ICS doses.

Main Results:

  • Fourteen RCTs involving 5768 children were analyzed.
  • A small, statistically significant improvement in forced expiratory volume in 1 second was observed with moderate ICS doses in mild-to-moderate asthma.
  • No significant differences in other efficacy outcomes or local adverse events were found between low and moderate doses.

Conclusions:

  • Moderate ICS doses may not offer clinically relevant therapeutic advantages over low doses in children with mild-to-moderate persistent asthma.
  • Current evidence suggests no clear dose-response relationship at low-to-moderate ICS levels.
  • Further research is recommended to clarify the ICS dose-response in childhood asthma.
Abstract

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