Salmeterol in paediatric asthma

Abstract

Background-The addition of long acting inhaled 2 agonists is recommended at step 3 of the British guidelines on asthma management but a recent study suggested no additional benefit in children with asthma. Methods-The aim of this study was to compare, in a double blind, three way, crossover study, the eVects of the addition of salmeterol 50 µg bd, salmeterol 100 µg bd, and salbutamol 200 µg qds in asthmatic children who were symptomatic despite treatment with inhaled corticosteroids in a dose of at least 400 µg/day over a one month period. Symptom scores, morning and evening peak expiratory flow (PEF) rates, use of rescue medication, spirometric indices, and histamine challenge were measured. Results-Forty five children aged 5-14 years were enrolled. All three treatments improved asthma control, morning and evening PEF rates, and spirometric indices with no change in bronchial hyperreactivity. Mean morning PEF was significantly better during the salmeterol treatment periods than with salbutamol treatment (p<0.05). The analysis of mean morning PEF gave an estimated treatment diVerence of 9.6 l/min for salmeterol 50 µg bd versus salbutamol 200 µg qds (95% confidence interval (CI) 2.1 to 17.1), and an estimated treatment diVerence of 13.8 l/min for salmeterol 100 µg bd versus salbutamol 200 µg qds (95% CI 6.0 to 21.5). There were no significant diVerences between the two doses of salmeterol and all treatments were well tolerated. Conclusions-In this population of moderate to severe asthmatic children on inhaled corticosteroids, salmeterol in a dose of either 50 µg bd or 100 µg bd is significantly more eVective at increasing the morning PEF rate over a one month period than salbutamol 200 µg qds. The data provided no significant evidence of a diVerence in eYcacy between the two doses of salmeterol, 50 µg and 100 µg. A trial of salmeterol 100 µg bd may be worth considering in those still symptomatic on the lower dose. (Thorax 2000;55:780-784)

Choosing Therapy for Childhood Asthma

“…[7] In a study among children with moderate to severe asthma and taking inhaled corticosteroids, salmeterol was significantly more effective at increasing morning peak expiratory flow rates (PEFR) over a 1 month period than salbutamol. [9] Among children with moderate asthma, no additional benefit was seen by the addition of either salmeterol or more beclomethasone to a daily dose of beclomethasone 400μg in children with excellent compliance. [10] A review of 30 double-blind, randomised, controlled trials on the effects of formoterol and salmeterol on lung function in children with asthma concluded that the evidence does not support the use of longacting β 2 -agonists as monotherapy, nor does it support their general use as regular add-on therapy.…”

Asthma in Children Management Issues for Family Doctors

“…Although salmeterol 50 micrograms twice daily provides significant improvement in lung function compared with placebo or 'as needed' salbutamol, beclamethasone 400 micrograms per day is more effective than salmeterol. 15 We feel one should consider salmeterol for children receiving optimal inhaled corticosteroid therapy who continue to experience symptoms requiring frequent bronchodilator therapy. Salmeterol should not be used as a rescue medication and its role in long term monotherapy is controversial and unproven.…”

To the editor: Reply to Dr. Bisgaard

“…The author states that the literature was explored with the use of standard search engines and then supplemented by a nonsystematic review. It is unclear why the author included these eight articles and why those by Weinstein et al, 2 Russell et al, 3 and Byrnes et al, 4 as examples, were excluded. Many of the included papers do not define exacerbations or require inhaled corticosteroid use, which the author states was the objective of the study.…”