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Step-down treatment viable option for some asthma patients
Checkley W. Lancet. 2011;doi:10.1016/S0140-6736(10)62313-6.
Martinez F. Lancet. 2011;doi:10.1016/S0140-6736(10)62145-9.
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Daily inhaled corticosteroid use remains the gold standard to prevent asthma flare-ups, but rescue therapy may be an effective step-down option for children who have mild, well-controlled asthma, according to a study published online this week.
Fernando D. Martinez, MD, of the University of Arizona, and colleagues looked at 288 children who were assigned to one of four treatment groups to look at the relative effectiveness of daily treatment compared with rescue therapy.
Children were assigned to either the combined group, which was twice-daily beclomethasone with beclomethasone plus albuterol (salbutamol) as rescue (71 patients); the daily beclomethasone group, which was twice-daily beclomethasone with placebo plus albuterol as rescue (72 patients); the rescue beclomethasone group, which was twice-daily placebo with beclomethasone plus albuterol as rescue (71 patients); or the placebo group, which was twice-daily placebo with placebo plus albuterol as rescue (74 patients).
The researchers said compared with the placebo group, the frequency of exacerbations was lower in the daily (28%), combined (31%) and rescue (35%) groups, with the combined and rescue results of borderline statistical significance.
Frequency of treatment failure was 23% in the placebo group vs. 6% in the combined, 3% in the daily and 8.5% in the rescue groups. The researchers said the regimens containing daily beclomethasone was associated with growth inhibition, with linear growth about 1.1 cm less in the combined and daily arms (P<.0001).
“We speculate that rescue inhaled corticosteroids could also be an alternative, step-two therapeutic approach for mild persistent asthma even in individuals who have not previously received a course of daily corticosteroid treatment, but our study was not designed to specifically address this issue,” the researchers said.
“The results of this trial suggest that step-down from daily inhaled corticosteroids to such treatment as rescue in combination with rescue short-acting beta-agonists could be an effective step-down strategy for patients with mild persistent asthma,” William Checkley, MD, of Johns Hopkins University, wrote in an accompanying commentary.
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