Steroid sparing using safer drugs in the management of children and adolescents with chronic asthma

ABSTRACT

This study included forty five [19 males and 26 females] children and adolescent patients [mean age 11.2 +/- 3.4 years] suffering from chronic bronchial asthma, in whom oral and/or inhaled steroids were necessaary to control their symptoms. They were selected from patients attending outpatient clinics of Pediatrics and Chest Departments of Tanta University Hospital. They were assigned randomly into 3 treatment groups [15 cases each]; Lidocaine group receiving nebulized lidocaine 1 mg/kg/dose twice daily, Montelukast group receiving oral montelukast 5 mg once daily, and control group who continued on their traditional drugs [bronchodilators and steroids]. History and clinical examination were performed and the following investigations were done to all study cases as a base line and after 2 weeks of treatment PEFR, FEV1, FEF[25.75%], Induced sputum was collected and utilized to do sputum eosinophil count, sputum eosinophilic cationic protein [ECP] and sputum nitric oxide [NO] metabolites [nitrites and nitrates]. PEFR increased significantly 20 minutes after lidocaine inhatation, indicating bronchodilating effect of lidocaine. Studied pulmonary function parameters [PEFR, FEV1 and FEF[25-75%], significantly increased, while induced sputum analysis data [sputum eosinophil count % and sputum ECP] significantly decreased after treatment in Iidocaine and montelukast groups as compared to base line values and control group. However, the difference between the two groups after treatment was not significant. Sputum total nitriteslnitrafes did not change significantly after treatment in both groups and in controls due to pretreatment of ail study cases with steroids. Successful steroid withdrawal was obtained in 86% of lidocaine group and 73% of montelukast group along of 2 weeks. The difference between success rates in the two groups was statistically insignificant [p0.05]