Good News on Inhaled Corticosteroids in Children

Two new studies provide some comfort for physicians and parents who worry about the potential side effects in children from using inhaled corticosteroids for wheezing or asthma. 

Dr. Pederson (Photo by Sherry Boschert)

One long-term Danish study (the Scandinavians excel at longitudinal studies) found no bad eye effects, which previous less-rigorous studies had hinted at. Dr. Søren Pederson of the University of Southern Denmark and his associates followed 148 children using daily inhaled budesonide for chronic asthma from childhood into adulthood. They compared eye exam results in these patients 15-20 years after they began therapy to exam results in 53 of their siblings who did not have asthma and didn’t use budesonide. The ophthalmologist who evaluated all exam results did not know which exams came from the asthmatic kids and which came from healthy siblings.

They found that long-term daily budesonide use didn’t cause more cataracts or significantly change intraocular pressure or vision, Dr. Pederson reported at the annual meeting of the American Academy of Allergy, Asthma and Immunology. AstraZeneca, which markets budesonide, funded the study. The investigators said they had no other potential conflicts of interest.

A separate study validated an alternative to daily inhaled corticosteroids in wheezing toddlers. Clinicians and parents worry about this recommended treatment strategy, because previous studies have shown that daily inhaled corticosteroids have a small but statistically significant class effect of reducing growth in preschool-aged children that only partially reverses if the corticosteroids are stopped, Dr. Leonard B. Bacharier said.

Dr. Bacharier (Photo by Sherry Boschert)

The multicenter, randomized, double-blind, placebo-controlled trial compared the recommended regimen for wheezing toddlers – daily low-dose budesonide – with an alternative regimen, intermittent high-dose budesonide. The intermittent budesonide group got daily placebo and received a 7-day course of high-dose budesonide only when they developed a respiratory tract illness.

Both treatment regimens proved effective, but the daily budesonide group was exposed to more than three times the cumulative amount of inhaled corticosteroid over a year’s time, compared with the intermittent group, Dr. Bacharier of Washington University and his associates reported. Read more in the full story.

Studies like these should help those who care for children with asthma breathe a little easier.

–Sherry Boschert (on Twitter @SherryBoschert)

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Filed under Allergy and Immunology, Emergency Medicine, Family Medicine, IMNG, Internal Medicine, Pediatrics

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