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Long-term intervention in childhood asthma: the Dutch study results. Dutch Chronic Nonspecific Lung Disease Study
1Dept of Paediatrics, Erasmus University of Rotterdam, The Netherlands.
Insights
Inhaled corticosteroids improved asthma control in children, but stopping treatment led to symptom relapse and decreased lung function. Continuous treatment maintained stable lung function and airway responsiveness in asthmatic children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Therapeutics
Background:
- Asthma management in children requires long-term strategies.
- Evaluating the efficacy and safety of inhaled corticosteroids (ICS) is crucial.
- Understanding the impact of ICS cessation on pediatric asthma is important.
Purpose of the Study:
- To compare different asthma treatment regimens in children.
- To assess the long-term effects of inhaled budesonide on asthma control.
- To investigate the consequences of discontinuing inhaled corticosteroids in pediatric asthma patients.
Main Methods:
- A multicenter intervention study involving asthmatic children.
- Part 1: Randomized controlled trial comparing salbutamol with budesonide vs. salbutamol alone.
- Parts 2 & 3: Long-term follow-up and cessation study of inhaled corticosteroid treatment.
Main Results:
- The inhaled corticosteroid group showed significant improvements in symptoms, lung function (FEV1, PEF), and airway responsiveness (PD20 histamine).
- During long-term follow-up, remission rates were high, but relapses occurred upon cessation of treatment.
- Cessation of inhaled corticosteroids led to increased symptoms and decreased lung function and airway responsiveness.
Conclusions:
- Long-term inhaled corticosteroid therapy is effective in improving asthma control in children.
- Discontinuation of inhaled corticosteroids can lead to relapse and deterioration of lung function.
- Continuous inhaled corticosteroid treatment is necessary for maintaining stable asthma control in children.
Abstract:
In The Netherlands, a long-term multicentre intervention study was performed in asthmatic children, comparing different treatment regimens. The study consists of three integrated parts. Part 1, 116 children randomized to receive either 0.2 mg salbutamol plus 0.2 mg budesonide t.i.d. (steroid group) or 0.2 mg salbutamol plus placebo t.i.d. (placebo group). Endpoints were symptoms, airway calibre, expressed as forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) before and after bronchodilation, and airway responsiveness (PD20 histamine). Part 2, steroid group follow-up of 28-36 months. The further course of endpoints and the remission (symptom-free during any 8 month period) rate were studied. Part 3, the effect of cessation of long-term administration of inhaled corticosteroid on FEV1 PD20 histamine and symptoms was investigated for 6 months in 28 steroid group children. Randomization (2:1) to either decrease and stop (after 2 months) corticosteroid (cessation group), or to continue treatment (continuous group). Part 1, withdrawals: placebo group 26/58; steroid group 3/58. This part of the study was stopped after a median follow-up period of 22 months. All endpoints improved in the steroid group and PD20 histamine continued to improve and remained unchanged in the placebo group. Part 2, symptoms tended to improve during the whole follow-up period. PD20 histamine plateaued after 22 months at a subnormal level. Thirty five patients (60%) achieved a remission during treatment; 23 (66%) relapsed. Part 3, 8/20 in the cessation group withdrew (symptoms increased, FEV1 and PD20 histamine decreased). In the continuous group no withdrawals occurred (FEV1 and PD20 histamine remained stable).(ABSTRACT TRUNCATED AT 250 WORDS)