In the News
May 11, 2006
Contact: Liz Beckett, (520) 626-5954
or Dr. Theresa Guilbert (520) 626-5060
Long-term inhaled corticosteroids in preschool children at high risk for asthma. New England Journal of Medicine. 2006 May 11; 354(19):1985-97.
Daily treatment with inhaled corticosteroids can reduce breathing problems in pre-school-aged children at high risk for asthma but they do not
prevent the development of persistent asthma in these children, according to new results from this study lead by the Arizona Respiratory Center.
It was conducted as part of the Childhood Asthma Research and Education (CARE) Network supported by the National Heart, Lung, and Blood Institute (NHLBI)
of the National Institutes of Health. In the Prevention of Early Asthma in Kids (PEAK) multicenter clinical trial, 285 children ages 2 to 3 years at
high risk for asthma were randomly selected to receive either daily treatment of inhaled corticosteroid treatment (fluticasone propionate [Flovent] 88 mcg
twice daily, using a metered-dose inhaler with a valve spacer and mask) or placebo for two years. All children in the study received additional medication
to treat symptoms if they occurred. After two years, daily use of inhaled corticosteroids (or placebo) was stopped, and all participants were observed for
an additional year to determine if the earlier treatment had lasting effects. Researchers report no significant differences between the participants in the
treatment group and participants in the control (placebo) group during this observation period. During the two-year treatment period, however,
children treated with the daily inhaled corticosteroids had significantly fewer and less severe asthma symptoms than their peers who were given placebo.
For example, children treated with inhaled corticosteroids had on average 2 days of symptoms per month compared to 4 days of symptoms per month in the
placebo group. They also had a lower rate of severe asthma exacerbations requiring additional treatment with oral corticosteroids and had less need for
leukotriene receptor antagonists or additional inhaled steroid treatments. The researchers found that the inhaled corticosteroids appeared to slow
the growth of the children in the treatment group; however, this effect appeared to be temporary. The difference in growth rate was significant between the
two groups during the first year of the study, but not during the second year of treatment. During the third-year observation period, the children who had
been regularly treated with inhaled corticosteroids grew more quickly than the children who had not received inhaled corticosteroids. Overall, the children
in the placebo group grew an average of 1.1 cm more than the children in the treatment group after two years, but by the end of the three-year study, the
difference in average increase in height dropped to 0.7 cm. Guidelines from the National Asthma Education and Prevention Program recommend inhaled
corticosteroids or another daily long-term control medication in older children and adults with persistent asthma to prevent symptoms and quick-relief
medication such as inhaled bronchodilator to treat acute asthma symptoms if they occur. The results of the PEAK study provide strong support for extending
the use of inhaled corticosteroids, for the same reasons, to pre-school children at high risk for asthma.
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