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Inhaled steroids compared with disodium cromoglycate in preschool children with episodic viral wheeze
F De Baets1, S Van Daele, H Franckx
1Pediatric Pulmonology University Hospital, Gent, Belgium.
Insights
Beclomethasone dipropionate (BDP) was more effective than disodium cromoglycate (DSCG) in preventing wheezing exacerbations in preschool children. Neither drug significantly reduced bronchial responsiveness in this age group.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Wheezing is common in preschool children, often linked to viral infections rather than atopy.
- Established treatments for atopic asthma in older children include disodium cromoglycate (DSCG) and beclomethasone dipropionate (BDP).
- The efficacy of these inhaled anti-inflammatory drugs for preventing episodic wheezing in younger children is less understood.
Purpose of the Study:
- To compare the efficacy of regular inhaled disodium cromoglycate (DSCG) and beclomethasone dipropionate (BDP) for preventing wheezing in preschool children.
- To assess if regular treatment with these inhaled anti-inflammatory drugs reduces bronchial responsiveness.
- To evaluate the impact on daily peak flow measurements and wheezing exacerbations.
Main Methods:
- A double-blind, crossover study involving 15 preschool children (median age 56 months).
- Patients received either DSCG (10 mg thrice daily) or BDP (100 microg thrice daily) for 2 months, followed by a crossover period after a wash-out.
- Bronchial responsiveness was measured using histamine provocation tests (PC100his), alongside daily peak flow monitoring and recording of exacerbations.
Main Results:
- Neither DSCG nor BDP showed a significant decrease in bronchial responsiveness (PC100his).
- Beclomethasone dipropionate (BDP) therapy resulted in significantly higher morning peak flows compared to DSCG (160 vs. 150 L/min, P < 0.03).
- BDP treatment led to significantly fewer wheezing exacerbations (7) than DSCG therapy (16, P < 0.005).
Conclusions:
- In preschool children experiencing episodic, virally induced wheezing, beclomethasone dipropionate (BDP) is superior to disodium cromoglycate (DSCG) for preventing wheezing exacerbations.
- Neither inhaled anti-inflammatory drug demonstrated a significant effect on reducing bronchial responsiveness in this population.
- BDP offers a more effective therapeutic option for managing wheezing symptoms in this specific pediatric group.
Abstract:
In school children with atopic asthma the beneficial effects of disodium cromoglycate (DSCG) and beclomethasone dipropionate (BDP) are well-established. In preschool children, wheezing is quite common, and in the majority of cases the symptoms are episodic and reported to be associated with viral infections rather than atopy. We compared the efficacy of regular treatment with DSCG and BDP for prevention of wheezing in preschool children. We were interested to establish whether regular treatment with inhaled anti-inflammatory drugs could lead to a decrease in bronchial responsiveness. In 15 patients (median age, 56 months; range, 43-66 months) bronchial responsiveness was assessed by measuring specific airway resistance (sRaw) during a histamine provocation test. The concentration of histamine eliciting a 100% increase in sRaw (PC100his) was determined. In a double-blind crossover study, patients inhaled either DSCG 10 mg three times a day or BDP 100 microg three times a day for 2 months. After a wash-out period, treatment was changed to BDP or DSCG, respectively. Daily peak flow measurements were carried out, and exacerbations were noted. PC100his was measured at the start and end of each treatment period. No significant decrease in bronchial responsiveness was seen (PC100his DSCG: before 1.3, after 1.66 mg/ml, Pvalue not significant; BDP: before 1.1 after 1.22 mg/ml, Pvalue not significant). Significantly higher morning peak flows were observed on BDP therapy (160 on BDP vs. 150 L/min on DSCG, P < 0.03). BDP treatment resulted in significantly fewer wheezing exacerbations (7 vs. 16, P < 0.005) compared with DSCG therapy. We conclude that in preschool children with episodic virally induced wheezing, BDP therapy was superior to DSCG aerosol treatments for the prevention of exacerbations of wheezing, although no significant effect on bronchial responsiveness was noted during either treatment protocol.