Long-Term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma

Guilbert, Theresa W.; Morgan, Wayne J.; Zeiger, Robert S.; Mauger, David T.; Boehmer, Susan J.; Szefler, Stanley J.; Bacharier, Leonard B.; Lemanske, Robert F.; Strunk, Robert C.; Allen, David B.; Bloomberg, Gordon R.; Heldt, Gregory P.; Krawiec, Marzena; Larsen, Gary L.; Liu, Andrew H.; Chinchilli, Vernon M.; Sorkness, Christine A.; Taussig, Lynn M.; Martínez, Fernando D.

doi:10.1056/nejmoa051378

Cited by 950 publications

(719 citation statements)

References 26 publications

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“…In addition to clinical control during the active treatment period, a reduction in growth rate, with partial recovery during the follow-up period, was also recorded. 51 A recent double-blind, placebo-controlled study with children treated with different doses of inhaled ciclesonide did not document changes in either lower leg growth rate or effects on the HAP axis. 52,53 Ocular toxicity…”

Section: Linear Growthmentioning

confidence: 94%

Corticosteróides inalados no tratamento da alergia respiratória: segurança versus eficácia

Rizzo¹,

Solé²

2006

J. Pediatr. (Rio J.)

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Objective: Review the molecular mechanisms of action, efficacy, and potential side effects associated with inhaled corticosteroids (ICS) in children with persistent asthma.Sources: Articles in English from MEDLINE. The following terms were used: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, and oral candidiasis. Treatment guidelines, review articles, controlled trials, meta-analyses, and systematic reviews evaluating the efficacy and the adverse events of treatment with ICS were selected.Summary of the findings: In vivo and in vitro studies show that the available ICS have different pharmacokinetic and pharmacodynamic properties that result in different action potentials. ICS also differ as to the systemic and local side effects. The bioavailability of these products is essential in order to determine the incidence of side effects. In general, ICS are capable of controlling asthma, reducing the number of exacerbations, medical consultations, hospitalizations, and the need of oral corticosteroid (applications) bursts. Improvement can also be seen in pulmonary function, especially in patients with recent onset asthma. The most documented adverse effect is transitory decrease of growth rate.

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Section: Linear Growthmentioning

confidence: 94%

Corticosteróides inalados no tratamento da alergia respiratória: segurança versus eficácia

Rizzo¹,

Solé²

2006

J. Pediatr. (Rio J.)

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“…To this end, treatment of 2-to 4-year old children with a positive asthma predictive index (i.e., those children most likely to develop asthma) for 2 years with an inhaled corticosteroid resulted in a significant improvement in days without symptoms, a reduced risk of exacerbations requiring prednisone, and less demonstrable airflow obstruction while the treatment was being administered compared with those children treated with placebo. Unfortunately, subsequent cessation of treatment resulted in deterioration in asthma control within 3 months that resulted in a level that was comparable to those children previously treated with placebo (13). Thus, while early intervention with inhaled corticosteroids in high-risk chil-dren can clearly reduce symptom burden, it does not appear to alter the ultimate expression of the underlying disease process once the treatment is stopped.…”

Section: When Is the Right Time To Treat?mentioning

confidence: 96%

“…To this end, an asthma predictive index was developed after prospective observations in a birth cohort study and the subsequent developmental ascertainment of risk factors (Table 1) (11). This index, with subsequent slight modification (12), is helpful in determining ''who'' may be the right child to treat to reduce symptom burden and exacerbations (13).…”

Section: Who Is the Right Patient?mentioning

confidence: 99%

Asthma Therapies Revisited: What Have We Learned?

Lemanske

2009

Proceedings of the American Thoracic Society

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Asthma is a heterogenous disorder related to numerous biologic, immunologic, and physiologic components that generate multiple clinical phenotypes. Further, genetic and environmental factors interact in ways that produce variability in both disease onset and severity and differential expression based on both the age and sex of the patient. Thus, the natural history of asthma is complex in terms of disease expression, remission, relapse, and progression. As such, therapy for asthma is complicated and has been approached from the standpoints of primary, secondary, and tertiary prevention. Presently, asthma cannot be cured but can be controlled in most patients, an indication that most of the success clinical research strategies have realized has been in the area of tertiary prevention. Since for many adult patients with asthma their disease had its roots in early life, much recent research has focused on events during early childhood that can be linked to subsequent asthma development with the hopes of creating appropriate interventions to alter its natural history of expression. These research approaches can be categorized into three questions. Who is the right patient to treat? When is the right time to begin treatment? And finally, what is the appropriate treatment to prescribe?

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“…This was not observed for the association LTA + IC. 48 Therefore, long-term studies will be able to confirm whether or not addition of montelukast to IC in severe asthma is truly beneficial.…”

Section: Lta Versus Intranasal Corticosteroids In Allergic Rhinitismentioning

confidence: 99%

Antileucotrienos no tratamento da asma e rinite alérgica

Ribeiro¹,

Toro²,

Baracat³

2006

J. Pediatr. (Rio J.)

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Objective: To compare leukotriene antagonists (LTA) to other groups of drugs used in asthma and allergic rhinitis treatment.Sources: MEDLINE, LILACS and Cochrane Library. Keywords: leukotrienes, antileukotrienes, asthma treatment, allergic rhinitis treatment, asthma and allergic rhinitis. An attempt was made to group the main studies and reviews about this topic Summary of the findings: LTA are more efficient than placebo and enhance the effects of inhaled corticosteroids. The association of inhaled corticosteroids with long-acting ß2 agonists is more efficient than the association of inhaled corticosteroids + LTA. Although use of LTA in acute asthma attacks and allergic rhinitis seems reasonable, more studies are needed to confirm this benefit. LTA reduce hospitalization time and the number of wheezing attacks in infants with acute viral bronchiolitis caused by respiratory syncytial virus, as well as recurrent wheezing after acute viral bronchiolitis. LTA are less efficient than intranasal corticosteroids for allergic rhinitis management. LTA are efficient in exercise-induced asthma, although they are not the first-line treatment. Conclusion:Controlled and randomized studies show that inhaled corticosteroids are the drugs of choice to treat persistent asthma and allergic rhinitis. There is not enough evidence to recommend the use of LTA as first-line drug (monotherapy) in children with asthma (level I). For children who cannot use inhaled corticosteroids, LTA may be a good alternative (level II).J Pediatr (Rio J). 2006;82(5 Suppl):S213-21: Asthma, exercise-induced asthma, rhinitis, antileukotrienes, montelukast, zafirlukast.

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Long-Term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma

Cited by 950 publications

References 26 publications

Corticosteróides inalados no tratamento da alergia respiratória: segurança versus eficácia

Corticosteróides inalados no tratamento da alergia respiratória: segurança versus eficácia

Asthma Therapies Revisited: What Have We Learned?

Antileucotrienos no tratamento da asma e rinite alérgica

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