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Selections from Journal Watch Pediatrics and Adolescent MedicineCopyright © 2006 Massachusetts Medical Society. All rights reserved.

Can early inhaled steroids modify the course of asthma in children?▸

Some authorities believe that early use of inhaled corticosteroids may alter the natural history of asthma in children. Two studies examined this contention.

U.S. investigators randomly assigned 285 preschool children (age range, 2–3) who were at high risk for developing asthma (history of 4 or more wheezing episodes and other risk factors) to receive either twice-daily fluticasone (88 µg) or placebo for 2 years, followed by a 1-year observation period without medication. Not surprisingly, during the treatment period, children who received inhaled corticosteroids had significantly fewer exacerbations that required systemic corticosteroids, required fewer supplemental controller medications, and had better lung function than placebo recipients. However, at the end of the observation period, no differences in lung functions were noted between groups.

In another study, Danish investigators randomly assigned 301 infants whose mothers had a history of asthma to receive either 2 weeks of inhaled budesonide (440 µg/day) or placebo during wheezing episodes beginning with the first 3-day episode (mean age at first episode, 11 months). After 3 years, no differences were noted between groups in the number of symptom-free days or the percentage of children with persistent wheeze.


These disappointing results deflate our hopes that the early use of inhaled corticosteroids might modify the natural history of asthma. These results confirm that steroids …

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