Rapid and Sustained Improvement Following Aerosolized Steroid for Chronic Lung Disease - an Intervention Study 1671

Abstract

Despite advances in management of newborn respiratory care, chronic lung disease (CDL) continues to be a major cause of increased morbidity. Long-term impairment of lung function is common. Treatment with systemic steroids may improve short term pulmonary outcome but concerns regarding long-term side effects limit their use. Our objective was to determine if inhalation steroids in doses used for childhood asthma can rapidly improve and sustain pulmonary function in oxygen dependent, spontaneously breathing very low birth weight (VLBW) infants with CLD. Material and Methods. 19 VLBW infants (mean GA: 26 wk, mean BW: 806g) were included at a mean postnatal age of 40 wk. Enrollment criteria were oxygen dependency (FiO2 0.25-0.40) increased work of breathing (WOB) and slow clinical improvement. All infants had radiological signs of CLD grade III (Toce 1984), >50% reduction in static compliance (CRs 40 cmH20/1/min.kg). CRs, Rrs, ventilation(VE), respiratory rate (RR), and peak inspiratory (PIF) and expiratory flow (PEF) were determined before treatment and at 4-6 wk intervals. Aerosolized budesonide® was given at 200-250 mcg.kg b.i.d. until oxygen dependency resolved and at 100-125 mcg b.i.d. until all lung function indices returned to normal. Statistics. Time dependent changes in pulmonary function and length of treatment were analyzed using analysis of variance test for homogeneity and/or multiple regression. Results. Oxygen dependency and clinical symptoms subsided within 1-4 wk. This was accompanied by a significant improvement in CRs (p=0.02), decrease in Rrs (p=0.01) and decrease in VE (p=0.01). A significant increase in PIF and PEF (80%) was observed within 12 weeks. Crs, RRs, VE, RR and PEF were in normal range within 15 weeks in 15 of the 19 infants. There were no clinical relapses after the discontinuation of therapy, and no airway or mouth infections were observed. Conclusions. Inhalation steroid therapy is feasible in VLBW and results in a rapid and sustained improvement in clinical symptoms and pulmonary function. Clinical symptoms disappear long before pulmonary function becomes normal. Large scale randomized trials are needed to establish the value of inhalation steroids for CLD.