Inhaled Corticosteroids and Asthma Control in Children: Assessing Impairment and Risk

  title={Inhaled Corticosteroids and Asthma Control in Children: Assessing Impairment and Risk},
  author={Gary S. Rachelefsky},
  pages={353 - 366}
OBJECTIVE. To review the use of inhaled corticosteroids on asthma control in children by using the new therapeutic paradigm outlined in the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. METHODS. A systematic review of the literature was performed by using the Medline and Embase databases (January 1996 to October 2007). RESULTS. A total of 18 placebo-controlled, clinical trials in >8000 children (aged 0–17 years) with asthma met the criteria for evaluating… 

Figures and Tables from this paper

Asthma therapy in pediatric patients: a systematic review of treatment with montelukast versus inhaled corticosteroids.
Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: a randomized controlled trial.
No precise physiologic, immunologic, or histologic characteristics can be used to definitively make a diagnosis of asthma, and therefore the diagnosis is often made on a clinical basis related to symptom patterns (airways obstruction and hyperresponsiveness) and responses to therapy (partial or complete reversibility) over time.
Asthma and other recurrent wheezing disorders in children (chronic).
A systematic review of the effectiveness and safety of the following interventions: beta(2) agonists (long-acting), corticosteroids (inhaled standard or higher doses), leukotriene receptor antagonists (oral), omalizumab, and theophylline (oral).
A control model to evaluate pharmacotherapy for allergic rhinitis in children.
Treatment of AR, particularly with intranasal steroids, improves disease control in children by reducing disease-associated impairment and risk, and all AR medications with proved efficacy probably improve impairment, paralleling symptom reduction.
High-dose nebulized budesonide is effective for mild asthma exacerbations in children under 3 years of age.
For children < 3 years old with mild asthma exacerbations, high-dose nebulized budesonide therapy is equally as effective as systemic steroid therapy.
e-Monitoring of Asthma Therapy to Improve Compliance in children (e-MATIC): a randomised controlled trial
E-Monitoring with tailored SMS reminders improves adherence to ICS, but not clinical outcomes in children with asthma, and costs were higher in the intervention group, but this difference was not statistically significant.
Nebulized Corticosteroids in Asthma and COPD. An Italian Appraisal
It is concluded that nebulizers may be considered as an effective alternative to inhalers for delivering ICSs and can be recommended to asthmatic and COPD subjects who are unwilling or unable to use inhalers.


Safety of inhaled corticosteroid therapy in young children with asthma.
Long-term inhaled corticosteroids in preschool children at high risk for asthma.
In preschool children at high risk for asthma, two years of inhaled-corticosteroid therapy did not change the development of asthma symptoms or lung function during a third, treatment-free year, and these findings do not provide support for a subsequent disease-modifying effect of inhaling corticosteroids after the treatment is discontinued.
Significant variability in response to inhaled corticosteroids for persistent asthma.
It is possible that higher doses of ICSs are necessary to manage more severe patients or to achieve goals of therapy not evaluated in this study, such as prevention of asthma exacerbations, after a 24-week, parallel, open-label, multicenter trial.
A multiple-dosing, placebo-controlled study of budesonide inhalation suspension given once or twice daily for treatment of persistent asthma in young children and infants.
Results of this study demonstrate that BIS is effective and safe for infants and young children with moderate persistent asthma in a multiple dose range, and that QD dosing is an important option to be considered by the prescribing physician.
Daily versus as-needed corticosteroids for mild persistent asthma.
It may be possible to treat mild persistent asthma with short, intermittent courses of inhaled or oral corticosteroids taken when symptoms worsen, and further studies are required to determine whether this novel approach to treatment should be recommended.
Use of exhaled nitric oxide measurements to guide treatment in chronic asthma.
With the use of FE(NO) measurements, maintenance doses of inhaled corticosteroids may be significantly reduced without compromising asthma control.