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Combination drug therapy in children with exercise-induced bronchospasm
Insights
Inhaled metaproterenol and cromolyn can help block exercise-induced bronchospasm (EIB) in children with asthma, even when theophylline is ineffective. Some children may require a combination of all three medications for complete EIB control.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
Background:
- Exercise-induced bronchospasm (EIB) is a common asthma symptom in children.
- Theophylline is a standard treatment, but may not fully control EIB in all cases.
Purpose of the Study:
- To evaluate the effectiveness of inhaled metaproterenol and cromolyn in blocking EIB in children with moderately severe asthma.
- To determine if combination therapy is beneficial for children with persistent EIB despite theophylline treatment.
Main Methods:
- Fifty-three children with moderately severe asthma were studied.
- EIB was assessed by a 20% fall in FEV1 or 30% fall in FEF25-75.
- Children received therapeutic theophylline and were tested with inhaled metaproterenol and/or cromolyn prior to exercise.
Main Results:
- All 53 children experienced EIB while on theophylline.
- Inhaled metaproterenol completely blocked EIB in 47 children.
- Six children required a combination of theophylline, metaproterenol, and cromolyn for complete EIB blockage.
Conclusions:
- Inhaled metaproterenol is effective in blocking EIB in most children with asthma on theophylline.
- A subset of children may benefit from combination therapy including theophylline, metaproterenol, and cromolyn for optimal EIB management.
Abstract:
Fifty-three children with moderately severe asthma were studied to determine the capacity of drugs to block exercise-induced bronchospasm (EIB). All 53 children demonstrated EIB (as defined by a 20% fall in FEV1 or 30% fall in FEF25-75) while receiving therapeutic theophylline (serum level 10-20 micrograms/ml). EIB was completely blocked in 47 children by an inhaled metaproterenol 10 minutes prior to exercise, in addition to the theophylline. In six children, EIB was only partially blocked when either metaproterenol or cromolyn was added to the theophylline, but was completely blocked when all three drugs were used. A small group of children may benefit from combination therapy for EIB.