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Testing a lower steroid dose for asthmatic kids
The question: Having children inhale corticosteroids -- considered one of the most effective asthma medications -- leaves some parents worried about side effects that can include restricted growth. Might lower doses of the steroids, or use of other drugs, offer comparable protection?
This study randomly assigned 285 children, 6 to 14 years old and recently diagnosed with mild to moderate asthma, to one of three treatment groups: to inhale the corticosteroid Flovent Diskus (fluticasone) twice daily; to inhale Advair Diskus (a combination of fluticasone and the bronchodilator Serevent, or salmeterol) in the morning and Serevent again at night; or to take a chewable tablet of Singulair (montelukast), a leukotriene modifier, at night. Leukotriene modifiers reduce the production or block the action of substances that cause airway inflammation; corticosteroids also are anti-inflammatory drugs; and bronchodilators open constricted airways. After a year, children who had taken the combination inhalant (which included 100 micrograms of corticosteroid) or the twice-daily dose of corticosteroid (200 micrograms total) reported equal control of their symptoms. However, lung function tests showed greater improvement for those who took the higher daily dose of corticosteroids. In both cases, the group taking the leukotriene modifier recorded less favorable results. Growth measurements for all groups were basically the same.
Who may be affected by these findings? Children with asthma. Nearly half of the 20 million Americans diagnosed with asthma are children.
Caveats: The authors noted that some children may be more responsive to leukotriene modifiers than were children in the study. Longer use of the drugs tested might show a different effect on growth. Flovent, Advair and Serevent were provided by GlaxoSmithKline; nine of the 20 main authors had received fees from the drug company or from Merck, which makes Singulair.