Steroids in Young Children–too Much of a Good Thing?

 Intermittent budesonide therapy for children with recurrent wheezing 

Here’s the issue:  my doctor prescribes budesonide (or Pulmicort™) for my child’s asthma and tells me to use it EVERYDAY.  Is this really necessary?  Conventional wisdom says to use inhaled steroids or anti-inflammatory medications for asthma everyday or they don’t work well.  That attitude may now be challenged with this new study from the prestigious New England Journal of Medicine. 

That's a mouthful

This summary appears in the February issue of Journal of Clinical Allergy & Immunology.  Wow–that’s a mouthful!

Concerns over adherence and growth suppression in children with wheeze who are regularly treated with inhaled corticosteroids have prompted re-examination of some clinical guidelines by the National Heart, Lung, and Blood Institute‘s Childhood Asthma Research and Education Network. Zeiger et al (N Engl J Med 2011;365:1990-2001) compared low-dose, daily inhaled budesonide with intermittent budesonide therapy initiated at the beginning of respiratory tract infection and continued for 1 week in 278 children between the ages of 12 and 53 months with frequent, episodic wheezing at risk for asthma exacerbation.

The authors found that daily low-dose budesonide therapy did not differ significantly from the intermittent regimen with respect to the frequency of exacerbations. Although the difference in growth measures was not statistically significant between the 2 groups, they noted that the mean exposure to budesonide was greater in those undergoing the daily low-dose regimen.

Budesonide is given by nebulization as shown here

Zeiger et al commented that their findings of lack of superiority of daily low-dose budesonide to high-dose intermittent budesonide might be an important consideration in future clinical guidelines.

Lead author, Robert Zeiger, MD, PhD, at Kaiser Permanente and University of California, San Diego, gave us this comment: “Our study offers a treatment option for wheezing preschoolers. . .while the study may benefit many preschoolers who wheeze during respiratory illnesses, it did not evaluate children who have more severe disease or persistent symptoms.

Bottom line?  Maybe doctors can treat preschoolers who wheeze with intermittent inhaled steroids and avoid year-round use of budesonide.  Stay tuned.

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