Budesonide improves decreased airway conductance in infants with respiratory symptoms

Anna S Pelkonen ^1*, Kristiina Malmstr?m ¹, L Pekka Malmberg ¹, Seppo Sarna ², Markku Turpeinen ¹, Merja Kajosaari ¹, Tari Haahtela ¹ and Mika J M?kel? ¹

¹ Helsinki University Central Hospital, Finland
² University of Helsinki, Finland

^* To whom correspondence should be addressed. E-mail: anna.pelkonen{at}hus.fi.

Accepted 17 February 2009

Abstract

Objective: Inhaled corticosteroids (ICS) are commonly used to treat wheezing disorders in children but few studies have investigated the effect of ICS on lung function in infants. We evaluated the efficacy of inhaled budesonide for decreased specific airways conductance (sGaw) as an indication of bronchial obstruction in very young children with recurrent cough and/or wheeze.

Patient, design and interventions: Functional residual capacity (FRC) and sGaw of steroid-naive children aged 3-26 months with respiratory symptoms were measured using an infant whole-body plethysmograph. Clinically indicated bronchoscopy was performed in 79% of the patients to exclude anatomical abnormalities before randomization. Children with abnormal lung function and respiratory symptoms were randomized into two treatment groups, receiving either inhaled budesonide (400 µg/day) or placebo with Nebuchamber® for 6 weeks. Inhaled terbutaline 0.25 mg/dose was used as rescue medication. Lung function measurements were repeated after 6 weeks.

Main outcome measure: Lung function.

Results: Forty-four children, median age 11.3 months (range 3.7-25.9), completed the study. Median sGaw improved from z-score -3.6 to -1.2 (p < 0.001) in the budesonide group and from -3.2 to -2.6 (p = 0.033) in the placebo group; between group difference p=0.014. Improvement in sGaw was more pronounced in children with atopy (p = 0,017). Symptom-free days increased in both budesonide and placebo groups with no difference between the groups.

Conclusion: Treatment with inhaled budesonide for 6 weeks improved sGaw in young children with chronic cough or wheeze and bronchial obstruction.