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The benefits of maintenance therapy with inhaled corticosteroids have been convincingly established in patients with moderate and severe asthma disease, but only recently have studies assessed the potential benefits for children with mild disease. In this issue of Archives of Disease in Childhood, Turpeinen and colleagues report the findings of such a study.1 Their results confirmed that continuous treatment with inhaled corticosteroids is associated with significantly better asthma control than with treatment with disodium cromoglycate or intermittent treatment with inhaled corticosteroids. However, better asthma control was achieved at the expense of some reduction in annual growth. These findings corroborate the results of earlier, differently designed, much larger and longer studies on around 3000 children with mild asthma.2–4 So, there is good evidence that optimal or near optimal asthma control can be achieved in most children with mild asthma with inhaled corticosteroids. Furthermore, inhaled corticosteroids are clinically more effective and improve outcomes to a greater extent than any other asthma drug available for maintenance treatment in patients with mild, persistent asthma.2 5–7
However, the adverse effect on annual growth rates reported in the study of Turpeinen and colleagues and some other studies raises the question of whether it is justified to always aim for optimal near optimal asthma control even if the price could be an adverse effect on growth velocity. Should we accept a few more asthma exacerbations and a somewhat poorer daily asthma control and ensure a normal growth rate for these children? Unfortunately this cannot be answered in any way that fulfills the criteria for evidence-based decision making. However, the literature does provide data that may help answer these questions.
When interpreting the findings from controlled clinical studies and implementing them in daily clinical practice it is worth remembering the …
Competing interests: SP has served on advisory boards for GlaxoSmithKline AstraZeneca and Nycomed, and has received honoraria for educational activities organized by these three companies. His institution has received funding for research from AstraZeneca, GlaxoSmithKline, Merck and Nycomed.
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