Explain to interested patients that inhaled corticosteroids are known to be an effective therapy for persistent asthma, but some parents worry about their side-effects in children, especially on growth.
MADISON, Wis., Jan. 23 -- Inhaled corticosteroids are the most effective therapy for children with mild to moderate persistent asthma, found a randomized controlled trial.
A combination of steroids and beta-agonists -- aimed at reducing the steroid dose -- was less effective than steroids in controlling clinical measures of asthma, according to Christine Sorkness, PharmD., of the University of Wisconsin here.
Least effective was monotherapy with an oral leukotriene receptor antagonist, Dr. Sorkness and colleagues reported in the January issue of the Journal of Allergy and Clinical Immunology.
The multi-center Pediatric Asthma Controller Trial (PACT) was testing the hypothesis that lower doses of steroids, combined with a long-acting beta-agonist, would outperform steroids alone.
The primary outcome was the number of asthma control days in which there was no need for rescue medication, oral corticosteroids, or non-study asthma medications and there were no daytime symptoms, nighttime awakenings, unscheduled health care visits, emergency department visits, hospitalizations for asthma, or school absenteeism for asthma.
The study assigned 285 children between the ages of six and 14 to:
The study found:
The bottom line, Dr. Sorkness and colleagues concluded, is that despite the similarity in patient-measured outcomes, Flovent Diskus "provided significantly more improvement in lung function and in bronchial hyperresponsiveness and greater reduction in (exhaled nitric oxide) than PACT combination."
Also, they said, "for several of these other outcomes, PACT combination was not superior to montelukast, which in turn was inferior to fluticasone monotherapy for all assessed asthma control outcomes."
The trial does not support the use of a steroid-sparing strategy in these children, they said.