Related Experiment Videos
Comparison of different inhalation schedules to control childhood asthma
R Kraemer1, K Modelska, C C Aebischer
1Department of Pediatrics, University of Berne, Inselspital, Switzerland.
Insights
Optimal childhood asthma control requires a combination of bronchodilators like salbutamol with protective medications such as disodium cromoglycate (DNCG) or beclomethasone dipropionate (BDP). Symptom diaries proved more effective than peak flow measurements for assessing treatment efficacy.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Childhood asthma management often involves inhaled corticosteroids or mast cell stabilizers.
- Assessing treatment effectiveness in mild asthma requires sensitive and reliable methods.
- Combination therapy is frequently used to achieve optimal symptom control.
Purpose of the Study:
- To compare the efficacy of beclomethasone dipropionate (BDP) with salbutamol (S), disodium cromoglycate (DNCG) with S, and placebo with S in controlling mild childhood asthma over six months.
- To evaluate the impact of these treatments on lung function, pulmonary hyperinflation, bronchial obstruction, and bronchial hyperreactivity (BHR).
Main Methods:
- A 6-month, double-blind, placebo-controlled study involving 36 children with allergic perennial asthma.
- Participants used metered-dose inhalers (MDIs) with a Volumatic device, receiving either BDP+S, DNCG+S, or placebo+S.
- Assessments included daily symptom diary cards, peak flow (PF) measurements, and lung function tests at baseline, 2, and 4 months.
Main Results:
- Daily PF measurements showed high variability and were insensitive to significant treatment changes.
- Symptom diary evaluations indicated dramatic improvement within the first three months of treatment.
- The DNCG group demonstrated a significant improvement in bronchial hyperreactivity (BHR) (p = 0.02).
- Most patients on regular salbutamol and placebo experienced increased airway resistance.
Conclusions:
- For optimal control of mild childhood asthma, a combination therapy including a beta 2-stimulant (bronchodilator) and either DNCG or BDP (protector) is recommended.
- Symptom diaries are more sensitive indicators of treatment response than peak flow measurements in this population.
- Disodium cromoglycate showed a significant benefit in improving bronchial hyperreactivity.
Abstract:
In a double-blind, placebo-controlled study control of asthma was assessed by diary symptom cards, peak-flow measurements and lung function within 3 treatment groups over a 6 months period. 36 children (25 boys, 11 girls 5.5 to 13.2 years of age) with exogen allergic, perennial asthma inhaled either beclomethasone dipropionate (BDP) with salbutamol (S) or disodium cromoglycate (DNCG) with S or a placebo preparation with S from metered dose inhalers (MDI) through a large-spaced auxiliary device (Volumatic). At entry, after 2 and 4 months lung function tests were performed evaluating changes in the degree of pulmonary hyperinflation, bronchial obstruction, and bronchial hyperreactivity (BHR). Daily PF measurements showing wide variations (up to 10-12%) were insensitive to indicate any significant changes. In contrast evaluation of symptom diaries presented dramatic improvement during the first 3 months of the study. In addition, the DNCG group showed significant improvement of BHR (p = 0.02). Moreover, the majority of patients on regular therapy with salbutamol and placebo showed an increase of airway resistance. It is concluded that even in mild childhood asthma, for optimal control a combination of a beta 2-stimulant as bronchodilator and DNCG or BDP as protector should be applied.