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	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Gold, D. R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background It is unknown whether inhaled corticosteroids can modify the subsequent development of asthma in preschool children at high risk for asthma.

Methods We randomly assigned 285 participants two or three years of age with a positive asthma predictive index to treatment with fluticasone propionate (at a dose of 88 µg twice daily) or masked placebo for two years, followed by a one-year period without study medication. The primary outcome was the proportion of episode-free days during the observation year.

Results During the observation year, no significant differences were seen between the two groups in the proportion of episode-free days, the number of exacerbations, or lung function. During the treatment period, as compared with placebo use, use of the inhaled corticosteroid was associated with a greater proportion of episode-free days (P=0.006) and a lower rate of exacerbations (P<0.001) and of supplementary use of controller medication (P<0.001). In the inhaled-corticosteroid group, as compared with the placebo group, the mean increase in height was 1.1 cm less at 24 months (P<0.001), but by the end of the trial, the height increase was 0.7 cm less (P=0.008). During treatment, the inhaled corticosteroid reduced symptoms and exacerbations but slowed growth, albeit temporarily and not progressively.

Conclusions 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. These findings do not provide support for a subsequent disease-modifying effect of inhaled corticosteroids after the treatment is discontinued. (ClinicalTrials.gov number, NCT00272441 [ClinicalTrials.gov] .)

Source Information

From the Arizona Respiratory Center, University of Arizona, Tucson (T.W.G., W.J.M., F.D.M.); Kaiser Permanente, San Diego, Calif. (R.S.Z.); the University of California–San Diego, San Diego (R.S.Z., G.H.); Pennsylvania State University, Hershey (D.T.M., S.J.B., V.M.C.); National Jewish Medical and Research Center, Denver (S.J.S., G.L., A.H.L., L.M.T.); Washington University, St. Louis (L.B.B., R.C.S., G.R.B.); and the University of Wisconsin, Madison (R.F.L., D.B.A., M.K., C.A.S.).

Address reprint requests to Dr. Guilbert at the Division of Pediatric Pulmonary Medicine, Arizona Respiratory Center, University of Arizona, 1501 N. Campbell Ave., P.O. Box 245073, Tucson, AZ 85724, or at guilbert{at}arc.arizona.edu.

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Inhaled Corticosteroids and Children
Köhler D., Haidl P., Dellweg D., Bont L., Kimpen J. L.L., Ermers M. J.J., Baraldi E., Filippone M., Guilbert T., Martinez F. D., Szefler S. J., the Childhood Asthma Research and Education (CARE) Network Steering Committee , Bisgaard H., Gold D. R., Fuhlbrigge A. L.
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N Engl J Med 2006; 355:624-626, Aug 10, 2006. Correspondence

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