Dexamethasone-isonicotinate aerosol in the long-term treatment of steroid-dependent asthmatic children

Area of Science:

• Pulmonology
• Pediatric Allergy and Immunology
• Clinical Pharmacology

Background:

• Chronic perennial asthma in children often requires long-term systemic corticosteroid therapy.
• Systemic corticosteroid use is associated with significant side effects, including Cushingoid features.
• Alternative delivery methods for corticosteroids are needed to minimize systemic exposure.

Purpose of the Study:

• To evaluate the efficacy and safety of inhaled dexamethasone-isonicotinate aerosol (DIA) in children with steroid-dependent asthma.
• To assess the feasibility of withdrawing or reducing systemic corticosteroid therapy with DIA treatment.
• To monitor changes in pulmonary function and systemic side effects.

Main Methods:

• An open-label trial was conducted over one year.
• Twenty-nine children with steroid-dependent chronic perennial asthma received DIA.
• Systemic corticosteroid therapy was gradually withdrawn or reduced.

Main Results:

• Inhaled DIA demonstrated comparable asthma control to previous therapies.
• Oral corticosteroid therapy was successfully withdrawn in 27 patients and reduced in two.
• Significant improvements were observed in pulmonary function parameters, with reduced airway obstruction and lung hyperinflation.
• Cushingoid features resolved, and suppressed allergic manifestations reappeared.
• No increased incidence of respiratory tract infections was noted.

Conclusions:

• Inhaled dexamethasone-isonicotinate aerosol is an effective treatment for childhood asthma, enabling significant reduction in systemic corticosteroid dependence.
• DIA therapy improves lung function and resolves systemic side effects associated with oral corticosteroids.
• Further investigation into the long-term effects and management of reappearing allergic conditions is warranted.