ABSTRACT
OBJECTIVE: To compare the effect of inhaled budesonide given daily or as-needed on mild persistent childhood asthma. Patients, design and INTERVENTIONS: 176 children aged 5-10 years with newly detected asthma were randomly assigned to three treatment groups: (1) continuous budesonide (400 microg twice daily for 1 month, 200 microg twice daily for months 2-6, 100 microg twice daily for months 7-18); (2) budesonide, identical treatment to group 1 during months 1-6, then budesonide for exacerbations as needed for months 7-18; and (3) disodium cromoglycate (DSCG) 10 mg three times daily for months 1-18. Exacerbations were treated with budesonide 400 microg twice daily for 2 weeks. MAIN OUTCOME MEASURES: Lung function, the number of exacerbations and growth. RESULTS: Compared with DSCG the initial regular budesonide treatment resulted in a significantly improved lung function, fewer exacerbations and a small but significant decline in growth velocity. After 18 months, however, the lung function improvements did not differ between the groups. During months 7-18, patients receiving continuous budesonide treatment had significantly fewer exacerbations (mean 0.97), compared with 1.69 in group 2 and 1.58 in group 3. The number of asthma-free days did not differ between regular and intermittent budesonide treatment. Growth velocity was normalised during continuous low-dose budesonide and budesonide therapy given as needed. The latter was associated with catch-up growth. CONCLUSIONS: Regular use of budesonide afforded better asthma control but had a more systemic effect than did use of budesonide as needed. The dose of ICS could be reduced as soon as asthma is controlled. Some children do not seem to need continuous ICS treatment.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Anti-Asthmatic Agents/administration & dosage , Asthma/drug therapy , Budesonide/administration & dosage , Lung/drug effects , Administration, Inhalation , Adrenal Cortex Hormones/adverse effects , Anti-Asthmatic Agents/adverse effects , Asthma/physiopathology , Budesonide/adverse effects , Child , Child, Preschool , Cromolyn Sodium/administration & dosage , Cromolyn Sodium/adverse effects , Double-Blind Method , Drug Administration Schedule , Female , Growth/drug effects , Humans , Lung/growth & development , Male , Respiratory Function Tests , Treatment OutcomeABSTRACT
OBJECTIVES: To compare the acceptability, reproducibility, and sensitivity of spirometric outcome measures of airway caliber during challenge testing in children. DESIGN: FEV(1), forced expiratory volume in 0.75 s, forced expiratory volume in 0.5 s, and peak expiratory flow (PEF) were recorded during stepwise dosimetric histamine challenge tests. The responses were compared, and the reproducibility at baseline and from duplicate measurements at each challenge step was determined. PATIENTS: One hundred five children with newly diagnosed asthma, aged 5 to 10 years. RESULTS: Compared to PEF, FEV(1) showed better baseline reproducibility (p = 0.002) and higher sensitivity (p < 0.0001) during challenge testing, determined as the change normalized to the baseline variation, while the forced expiratory volumes were not significantly different in these respects. During challenge testing in subjects with acceptable flow-volume tracings, paired recordings of FEV(1) agreed within 0.1 L in 85% and within 0.2 L in 93% of measurements. During challenge testing, the reproducibility of FEV(1) measurements was not better than that of the other indexes. Failure to exhale long enough precluded the use of FEV(1) in 16 of the children, particularly the youngest children. CONCLUSIONS: The results demonstrated that the recently published guidelines for FEV(1) measurements during challenge tests can be applied to children. During challenge tests in asthmatic children, the advantage of the shorter fractions of forced expiratory volume was that they were more often acceptably recorded than FEV(1), while they showed as good reproducibility and were also equally sensitive in assessing changes in airway obstruction.
Subject(s)
Asthma/diagnosis , Forced Expiratory Volume/physiology , Patient Acceptance of Health Care , Peak Expiratory Flow Rate/physiology , Bronchial Provocation Tests , Child , Child, Preschool , Female , Humans , Male , Practice Guidelines as Topic , Reproducibility of Results , SpirometryABSTRACT
Respiratory syncytial virus (RSV) bronchiolitis in infancy can lead to bronchial hyper-reactivity or recurrent obstructive bronchitis. The aim of the present study was to determine whether the type of treatment has an influence on respiratory status after RSV bronchiolitis. The study involved 117 infants (mean age 2.6 months), who needed hospital treatment because of RSV bronchiolitis. The patients were divided randomly into three groups. All received the same symptomatic treatment. Group I children received symptomatic treatment only, group II children were treated for 7 days with inhaled budesonide, 500 microg three times per day, administered via a nebulizer. Group III children received nebulized budesonide, 500 microg twice per day for two months. Follow-up consisted of out-patient check-ups 2 and 6 months after the infection, and telephone contact two years after the infection. Statistically significant differences were seen between the groups. In group I 37% of the children had asthma, in group II 18%, and in group III 12%. According to the present study it seems that inhaled corticosteroid treatment during and after the acute phase of infant RSV bronchiolitis may have a beneficial effect on subsequent bronchial wheezing tendency.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Asthma/prevention & control , Bronchiolitis/drug therapy , Respiratory Syncytial Virus Infections/drug therapy , Administration, Inhalation , Adrenal Cortex Hormones/therapeutic use , Asthma/etiology , Bronchiolitis/complications , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/therapeutic use , Budesonide/administration & dosage , Budesonide/therapeutic use , Disease Management , Female , Humans , Infant , Infant, Newborn , Male , Outcome Assessment, Health Care , Respiratory Syncytial Virus Infections/complicationsABSTRACT
We have used the radioallergosorbent test (RAST) to determine IgE antibodies specific to wheat flour proteins in the sera of seven groups of patients. In some cases rye-specific IgE was also determined. Wheat and rye RAST scores showed a good correlation, presumably due to cross-reactions. Among bakers with asthma, positive scores, 0.5-3, occurred with a prevalence of 43%, and among children with eczema, scores in the range 0.5-4 were found with a prevalence of 54%. A score of 0.5 was a marginal value which was also occasionally encountered with sera from patient groups with no history of immediate hypersensitivity to wheat or rye. These groups included adults and children with allergic rhinitis and asthma, children from the general population and children with coeliac disease. The RAST appeared useful in the diagnosis of allergy to inhaled flour dust among bakers. Among children with eczema, positive wheat and rye RAST results were a common finding, which only occasionally could be linked to strong and unequivocal reactions to the foods in question. Both in bakers and children with eczema, wheat and rye RAST results showed good agreement with intracutaneous skin test results.
