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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 5, 2010
Insights
Cromolyn effectively managed chronic asthma in children, reducing reliance on bronchodilators. However, its success in decreasing steroid dependency was limited, especially in steroid-dependent cases.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Difficult-to-treat asthma in children presents significant management challenges.
- Long-term prophylactic strategies are crucial for chronic asthma control.
Purpose of the Study:
- To evaluate the long-term efficacy of cromolyn sodium prophylaxis in children with chronic asthma.
- To assess the potential for decreasing dependency on bronchodilators and corticosteroids.
Main Methods:
- Double-blind, crossover studies followed by a five-to-six-year open trial of cromolyn prophylaxis.
- Evaluation included clinical assessments, bronchodilator/corticosteroid use, peak expiratory flow rates, and exercise tolerance.
- IgE specific RAST was used to identify extrinsic allergic components.
Main Results:
- Cromolyn prophylaxis was effective for many children with chronic asthma.
- A significant number of patients remained dependent on bronchodilators or corticosteroids.
- Improvement in exercise tolerance was observed in some patients, but steroid reduction was challenging.
Conclusions:
- Cromolyn sodium serves as an effective prophylactic agent for pediatric chronic asthma.
- Reducing or discontinuing steroid use in steroid-dependent asthmatic children proved difficult with cromolyn.
- Further research is needed to optimize long-term asthma management strategies in children.
Abstract:
Ninety-five children with difficult to treat asthma were given cromolyn in double-blind, crossover studies. Of these, 70 were studied for the next five to six years by open trial cromolyn prophylaxis to determine decreasing dependency on bronchodilators or corticosteroids. Evaluated at two-month intervals, 28 children required prednisone and bronchodilators, 37 required round-the-clock bronchodilators only and five required neither. Peak expiratory flow rates were below 80% of predicted normal in eight patients, the remaining 62 showed reversibility of airways obstruction. Exercise-induced asthma was reported by 44 during the first two years but persistent improvement in exercise tolerance occurred in 24 patients. IgE specific RAST indicated a continuing extrinsic element in the etiology of 38 of 45 patients tested. Cromolyn was an effective prophylaxis for children with chronic asthma; however, it was difficult to evaluate in 17 steroid-dependent subjects. Attempts to reduce the need for and especially to discontinue steroids were not as successful as other reports indicate.
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