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Betamethasone 17 valerate aerosol and disodium chromoglycate in severe childhood asthma
Insights
Betamethasone 17 valerate improved asthma symptoms more than disodium cromoglycate in a trial. However, disodium cromoglycate is still the preferred treatment for severe childhood asthma.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Severe perennial asthma in children often presents challenges in achieving adequate symptom control.
- Disodium cromoglycate is a common first-line treatment, but some patients exhibit a poor clinical response.
Purpose of the Study:
- To compare the efficacy of disodium cromoglycate, betamethasone 17 valerate, and their combination in children with severe asthma unresponsive to disodium cromoglycate.
Main Methods:
- A 4-month, double-blind, randomized trial was conducted.
- Participants received placebo, disodium cromoglycate, betamethasone 17 valerate, or a combination for one month each.
Main Results:
- Both disodium cromoglycate and betamethasone 17 valerate improved symptoms and lung function compared to placebo.
- Betamethasone 17 valerate showed a greater improvement, potentially due to patient selection.
- No additional benefit was observed when combining the two drugs.
Conclusions:
- Corticosteroid aerosols like betamethasone 17 valerate offer symptom control without growth suppression risk in severe childhood asthma.
- Disodium cromoglycate remains the primary choice for severe childhood asthma.
- Corticosteroid aerosols are recommended for children who do not respond adequately to disodium cromoglycate.
Abstract:
Eleven children with severe perennial asthma and a poor clinical response to disodium cromoglycate were studied in a 4-month, double blind trial involving 1 month's treatment with placebo, disodium cromoglycate, betamethasone 17 valerate, and both drugs combined according to a predetermined random design. Each drug apparently reduced symptoms and improved daily peak flow and fortnightly spirometric measurements compared with placebo, but the improvement after betamethasone 17 valerate was greater in part because of the way this group of patients was selected. There did not appear to be any additional benefit when both drugs were used together. Betamethasone 17 valerate was not compared with beclomethasone diproprionate aerosol and there is no reason to believe it may be superior. Corticosteroid aerosols have potential hazards which may prove to equal those of long-term systemic steroids, but they offer the prospect of satisfactory control of symptoms without the risk of growth suppression in children with severe asthma. Disodium cromoglycate remains the drug of choice in severe childhood asthma and the use of corticosteroid aerosols should be confined to those children who fail to respond satisfactorily to disodium cromoglycate.