Cessation of Long-term Treatment with Inhaled Corticosteroid (Budesonide) in Children with Asthma Results in Deterioration

Abstract

Inhaled corticosteroid has been shown to be effective in the management of asthma. However, there is a lack of studies that assess the effect of cessation after long-term treatment with inhaled corticosteroid. This question was addressed in 28 children with stable asthma, aged 11 to 18 yr of age, who had completed 28 to 36 months of treatment with inhaled corticosteroid (budesonide 200 micrograms 3 times/day) and inhaled beta-2-agonist (salbutamol 200 micrograms 3 times/day). The children were randomized in a 1:2 ratio in a double-blind study either to continue budesonide (n = 8) during a period of 6 months or to decrease the dose of budesonide (n = 20) within 2 months, followed by placebo for 4 months. Treatment with salbutamol 600 micrograms daily was continued in both groups. Eight children from the tapering-off group withdrew, mainly due to symptoms of asthma, compared with none in the continuous treatment group. Five patients in the tapering-off group experienced exacerbations for which prednisolone was given, compared with none in the continuous treatment group. After tapering-off, symptoms of asthma and additional bronchodilator use increased, and both FEV1% predicted and PD20 histamine (provocation dose of histamine causing a 20% fall in FEV1) decreased, whereas these all remained unchanged in the group that continued treatment with inhaled corticosteroid. We conclude that in this study long-term treatment with 600 micrograms budesonide daily suppressed underlying mechanisms of asthma, but did not cure the disease.

Does ketotifen have a steroid-sparing effect in childhood asthma?

“…In the present study, airway reactivity and lung function remained stable in both groups of patients for 12 weeks after ICS withdrawal/reduction, although the placebo-treated patients were more symptomatic during this period, observations that are in keeping with the data of JUNIPER et al [18] and HAAHTELA et al [19]. In contrast, other investigators [20][21][22] have found that the beneficial effects of ICS, in terms of control of symptoms, lung function and airway reactivity, are not maintained after cessation of therapy. There is no single explanation for the conflicting results of the aforementioned studies.…”

Asthma: from childhood to adulthood

“…However, discontinuation of treatment with inhaled corticosteroids often led to exacerbation of the disease. The same result was shown by Waalkens et al (108), who performed a study with 28 children, aged 11-18 years, who had completed 28-36 months of treatment with inhaled corticosteroid and inhaled P,-agonist. In a double-blind study, they were randomized either to continue inhaled steroids or to join the tapering-off followed by placebo group, for a period of 6 months.…”

Diagnosis of asthma in children under five

“…There might be two reasons to prescribe daily inhaled corticosteroids to preschool children: firstly, for present relief of symptoms; and secondly, to prevent progression from intermittent to continuous wheeze. There have been at least four randomised controlled trials [42][43][44][45] which have shown quite clearly that early institution of inhaled or nebulised corticosteroids have no impact on disease progression. Therefore, the only reason to prescribe regular inhaled corticosteroids is if the present severity of the condition merits them; there is no evidence that withholding them will compromise future lung function.…”