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Long-term treatment with corticosteroids and ACTH in asthmatic children. I. A pulmonary function study with
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Children with severe asthma on long-term corticosteroid treatment showed persistent lung hyperinflation and sub-clinical bronchial obstruction. These issues worsened over five years, even with clinical improvement, indicating underlying airway changes in pediatric asthma.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Research
Background:
- Severe bronchial asthma in children often requires long-term corticosteroid therapy.
- Assessing sub-clinical airway obstruction is crucial for managing pediatric asthma.
- Understanding the long-term respiratory effects of asthma treatment in children is important.
Purpose of the Study:
- To evaluate lung volumes and bronchial obstruction in children with severe asthma on long-term treatment.
- To assess changes in respiratory function over a 5-year period in this patient group.
- To investigate the relationship between clinical improvement and objective lung function measures.
Main Methods:
- Studied 21 children (aged 6-17 years) with severe bronchial asthma.
- Pulmonary function tests were performed when patients were as symptom-free as possible.
- Follow-up examinations were conducted 5 years after the initial assessment.
Main Results:
- Children exhibited increased lung volumes and hyperinflation with a high end-expiratory level.
- Forced expiratory volume in 1 second (FEV1) was within normal limits, but FEV% indicated sub-clinical bronchial obstruction.
- After 5 years, hyperinflation and sub-clinical obstruction became more pronounced, despite clinical improvement in most patients.
Conclusions:
- Children with severe asthma on long-term corticosteroid treatment demonstrate persistent sub-clinical bronchial obstruction and hyperinflation.
- These respiratory abnormalities can progress over time, even when clinical symptoms improve.
- Objective pulmonary function testing is essential for monitoring children with severe asthma.
Abstract:
Twenty-one children aged 6-17 years with severe bronchial asthma and on long-term treatment with corticosteroids and/or ACTH, were studied when they were as symptom-free as possible. They were found to have increased lung volumes and hyperinflation with a high end-expiratory level. The forced expiratory 1-s volume (FEV1) was within +/- 2 SD for healthy children, but the FEV% was significantly decreased, as a sign of sub-clinical bronchial obstruction. Arterial oxygen tensions was within normal limits, except in one patient with clinical signs of bronchial obstruction. On re-examination 5 years later, hyperinflation and sub-clinical obstruction were even more pronounced, despite the fact that the majority of the patients had improved clinically.