Inhaled Steroid Monotherapy Seen Best for Mild-Moderate Pediatric Asthma
The following abstract reiterates what is already known and considered the standard of care, which is the use of inhaled corticosteroids for mild- moderate asthma. I was not surprised by the superiority of the inhaled steroid alone and inhaled steroid/ salmeterol arms over the montelukast arm, but what I found interesting is the finding that double dose inhaled steroid was superior to inhaled steroid/ salmeterol combo in terms of FEV1/FVC and other markers such as exhaled nitric oxide and maximum bronchodilator response. But what does this mean clinically? If these children are followed longitudinally, which I’m sure they will be, it would give us important information on the long-term relevance of these markers and give us further guidance on the use of higher dose ICS vs. ICS plus long acting beta-agonists.
Sorkness CA, Lemanske RF Jr, Mauger DT, Boehmer SJ, Chinchilli VM, Martinez FD, Strunk RC, Szefler SJ, Zeiger RS, Bacharier LB, Bloomberg GR, Covar RA, Guilbert TW, Heldt G, Larsen G, Mellon MH, Morgan WJ, Moss MH, Spahn JD, Taussig LM; for the Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute.
Clinical Science Center, University of Wisconsin, Madison.
BACKGROUND: More evidence is needed on which to base recommendations for treatment of mild-moderate persistent asthma in school-aged children.
OBJECTIVE: The Pediatric Asthma Controller Trial (PACT) compared the effectiveness of 3 regimens in achieving asthma control.
METHODS: A total of 285 children (ages 6-14 years) with mild-moderate persistent asthma on the basis of symptoms, and with FEV(1) >/= 80% predicted and methacholine FEV(1) PC(20) RESULTS: Fluticasone monotherapy and PACT combination were comparable in many patient-measured outcomes, including percent of asthma control days, but fluticasone monotherapy was superior for clinic-measured FEV(1)/forced vital capacity (P = .015), maximum bronchodilator response (P = .009), exhaled nitric oxide
CONCLUSION:Both fluticasone monotherapy and PACT combination achieved greater improvements in asthma control days than montelukast. However, fluticasone monotherapy was superior to PACT combination in achieving other dimensions of asthma control. Growth was similar in all groups.
CLINICAL IMPLICATIONS: Therefore, of the regimens tested, the PACT study findings favor fluticasone monotherapy in treating children with mild-moderate persistent asthma with FEV(1) >/= 80% predicted, confirming current guideline recommendations.
J Allergy Clin Immunol. 2007 Jan;119(1):64-72. Epub 2006 Nov 30