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The functional response of infants with persistent wheezing to nebulized beclomethasone dipropionate
Insights
Inhaled beclomethasone dipropionate (BDP) significantly improved lung function in infants with persistent wheezing after bronchiolitis. Steroid therapy may be beneficial for managing this condition.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Trials
Background:
- Persistent wheezing is a common sequela of acute bronchiolitis in infants.
- Infants with persistent wheezing often exhibit significant airway obstruction.
- The efficacy of inhaled corticosteroids in this population is not well-established.
Purpose of the Study:
- To evaluate the effect of inhaled beclomethasone dipropionate (BDP) on lung function in infants with persistent wheezing post-bronchiolitis.
- To assess the role of albuterol in conjunction with steroid therapy.
- To determine if BDP can improve airway obstruction and clinical symptoms.
Main Methods:
- A randomized, double-blind, crossover trial involving nine infants (15-36 weeks old) with persistent wheezing.
- Lung function was measured using whole-body plethysmography (thoracic gas volume, specific airway conductance) and a compression jacket (forced expiratory flow).
- Infants received either nebulized BDP or placebo for two weeks, with albuterol effects assessed before and after steroid treatment.
Main Results:
- BDP treatment led to a significant increase in specific airway conductance (SGaw) from 37% to 61% predicted (P < 0.005).
- Forced expiratory flow at resting lung volume (VmaxFRC) showed a non-significant increase from 24% to 42% predicted.
- Respiratory rate and clinical scores for retractions and wheezing significantly improved with BDP therapy (P < 0.01 and P < 0.001, respectively).
- Albuterol had no discernible effect on lung function.
Conclusions:
- Inhaled beclomethasone dipropionate demonstrates a significant beneficial effect on lung function in infants experiencing persistent wheezing after acute bronchiolitis.
- Steroid therapy may represent a valuable component in the management strategy for persistent wheezing in this pediatric population.
- Further research is warranted to confirm these findings and optimize treatment protocols.
Abstract:
Lung function was measured in nine infants, ages 15-36 weeks, who had persistent wheezing, apparently following acute bronchiolitis, before and after 2 weeks of treatment with either inhaled nebulized beclomethasone dipropionate (BDP) or placebo in a randomized, double blind, crossover trial. The effect of nebulized albuterol (Salbutamol) was measured before and after the steroid treatment. Thoracic gas volume (TGV) and specific airway conductance (SGaw) were determined using a whole body plethysmograph, and forced expiratory flow at resting lung volume (VmaxFRC) was determined with a thoracoabdominal compression jacket. All infants had marked airways obstruction before treatment with mean +/- SE VmaxFRC of 24 +/- 4% predicted and SGaw of 37 +/- 5% predicted. Two weeks of placebo treatment had no significant effect on lung function, but after 2 weeks of BDP inhalation there was a significant rise in SGaw to 61 +/- 7% (P less than 0.005). VmaxFRC increased to 42 +/- 13% but the difference did not reach significance. Respiratory rate and clinical score for retractions and wheezing also fell significantly with BDP therapy (P less than 0.01 and P less than 0.001 respectively). Albuterol had no effect on lung function either before or during steroid therapy. Steroids may have a role in the management of persistent wheezing following bronchiolitis.