Lung function in school-aged asthmatic children with inhaled cromoglycate, nedocromil and corticosteroid therapy

Abstract

Two-thirds of the children with asthma in our area use cromones and only one-third steroids as the maintenance therapy. This study aimed to evaluate our treatment policy based on the international consensus. Peak expiratory flow (PEF), dynamic spirometry and bronchodilation test results were therefore collected in 195 school-aged patients who visited our outpatient clinic in 1995. Sixty-four children (33%) used cromoglycate, 86 (44%) nedocromil and 45 (23%) inhaled steroids. Twenty-five (12%) needed combination therapy, mainly with salmeterol. Lung function results were good, and there were no significant differences between the therapeutic groups irrespective of whether pre- or postbronchodilator values were considered. PEF was decreased in eight (4%), forced expiratory volume in one second (FEVI) in four (2%) and maximum mid-expiratory flow (MMEF) in 33 (17%) patients. At least one result was decreased in 39 (20%) cases, in most cases (77%) MMEF alone. Significant rises after salbutamol inhalations were observed in 17 (9%) in PEF, in two (1%) in FEV1 and 20 (10%) in MMEF values. Thus, the bronchodilation test was positive in 33 (17%) cases, and in 22 (11%) cases it was the only sign of bronchial obstruction. Over 70% of the children with asthma can be treated with cromones by a stepwise treatment modality. Inhaled steroids can be restricted to those not controllable by cromones. Lung function tests, including postbronchodilator values, should be part of the follow-up of continuous maintenance medication for asthma.

Do inhaled steroids differ from cromones in terms of hospital admission rates for asthma in children?

“…Our results suggest that the difference in the numbers of readmissions was attributable to good symptom control of asthma by the inhaled steroids. The result is at odds with our earlier observations, which indicated that good symptom control, evaluated objectively by lung function measurements, could also be achieved by cromones in as many as 50 to 70% of children suffering from asthma (27). However, on closer examination, these results are not necessarily contradictory and, in fact, are in agreement with a study from Belgium (28).…”

Exhaled nitric oxide as a marker of atopic asthma

“…19 First, the children were carefully instructed on how to perform the test. The result of at least 75% of that of predicted was regarded as a normal.…”

“…According to our guidelines, children with mild-to-moderate asthma are treated with cromones and those with severe symptoms or those not responding to cromone therapy are treated with inhaled steroids. 19…”

“…The result of at least 75% of that of predicted was regarded as a normal. 19 First, the children were carefully instructed on how to perform the test. Thereafter, measurements were repeated at least three times and accepted if the FEV 1 variation was less than 5% and the printed graphic curves were appropriate and equal in shape.…”

Cromolyn sodium or nedocromil in childhood asthma: does it matter?

“…One study has followed children on both cromolyn sodium and on inhaled corticosteroids for prolonged periods (up to 16.8 years) and found no evidence of irreversible airway changes in either group [ 42]. Korhonen and colleagues report a study in 195 children in which treatment with cromolyn sodium or nedocromil resulted in pulmonary function tests no different from those treated with inhaled corticosteroids [ 43].…”