Can the response to a single dose of beclomethasone dipropionate predict the outcome of long-term treatment inchildhood exercise-induced bronchoconstriction?

Abstract

Exercise-induced bronchoconstriction (EIB) is a frequent and highly specific symptom of childhood asthma. Inhaled corticosteroids (ICS) are the mainstay of controller therapy for EIB and asthma; however, a proportion of asthmatic children and adolescents is less responsive to ICS. We hypothesized that a single dose response to ICS could function as a predictor for individual long-term efficacy of ICS. To assess the predictive value of the bronchoprotective effect of a single-dose beclomethasone dipropionate (BDP) against EIB for the bronchoprotective effect of 4weeks of treatment, using an exercise challenge test (ECT). Thirty-two steroid-naïve children and adolescents aged 6 to 18years with EIB were included in this prospective cohort study. They performed an ECT at baseline, after a single-dose BDP (200µg) and after 4weeks of BDP treatment (100µg twice daily) to assess EIB severity. The response to a single-dose BDP on exercise-induced fall in FEV1showed a significant correlation with the response on exercise-induced fall in FEV1 after 4weeks of BDP treatment (r=.38, p=.004). A reduction in post-exercise fall in FEV1 of more than 8% after a single-dose BDP could predict BDP efficacy against EIB after 4weeks of treatment with a positive predictive value of 100% (CI: 86.1-100%) and a negative predictive value of 29.4% (CI: 11.7%-53.7%). We found that the individual response to a single-dose BDP against EIB has a predictive value for the efficacy of long-term treatment with BDP. This could support clinicians in providing personalized management of EIB in childhood asthma.