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  • Continuous versus intermittent inhaled corticosteroid (budesonide) for mild persistent asthma in children—not too much, not too little

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Editorial
Continuous versus intermittent inhaled corticosteroid (budesonide) for mild persistent asthma in children—not too much, not too little
  1. Markku Turpeinen,
  2. Anna S Pelkonen,
  3. Olof Selroos,
  4. Kurt Nikander,
  5. Tari Haahtela
  1. Department of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
  1. Correspondence to Professor Tari Haahtela, Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital, Meilahdentie 2, FIN-00250 Helsinki, Finland; tari.haahtela@hus.fi

https://doi.org/10.1136/thoraxjnl-2011-200246

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The clinical efficacy of inhaled corticosteroids (ICSs) in asthma has been demonstrated in long-term intervention studies,1 2 and ICSs are recommended first-line treatment of persistent asthma, even in children.3 The long-term benefits of early intervention with ICS have been well documented in adults with asthma.4 In children, early intervention with ICS has not altered the natural history of the disease.1 We have recently finalised a series of studies related to the Helsinki Early Intervention Childhood Asthma Programme.5 The programme highlights the benefits and safety aspects of intermittent treatment with an ICS, budesonide, in comparison with continuous daily ICS and non-steroidal maintenance treatment. In this study, we summarise our experiences.

 In the 18-month intervention, we compared two budesonide regimens with a control group treated with a fixed dose of disodium cromoglycate (DSCG). The study evaluated the antiasthmatic efficacy and systemic effects of daily versus as-needed intermittent budesonide in prepubertal children with mild persistent asthma. The efficacy variables were morning peak expiratory flow, FEV1, the number of asthma exacerbations and asthma-free days. The indicators of systemic effect were standing-height velocity, bone mineral density (BMD), skin thickness, intraocular pressure and the occurrence of lens opacities.

Children aged 5–10 years (n=176) with newly detected asthma were randomised into three treatment groups: (1) continuous budesonide (400 μg twice daily for 1 month, 200 μg twice daily for months 2–6 and 100 μg twice daily for months 7–18), (2) budesonide, identical treatment to group 1 during months 1–6, then placebo as regular treatment and budesonide intermittently for exacerbations during months 7–18 and (3) DSCG 10 mg three times daily for months 1–18. Exacerbations were treated with budesonide 400 μg twice daily for 2 weeks. If an oral or parenteral corticosteroid was needed, the child was withdrawn …

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Footnotes

  • Funding Helsinki University Hospital Research Grant (grant number: TYH2008302). Funder role: Academic support.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by Helsinki University Hospital Ethical Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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