Inhaled Corticosteroid Therapy In Children Research Articles

The effects of maternal anxiety and attitudes on the adherence to inhaled corticosteroids in children with asthma.

Long-term inhaled corticosteroid (ICS) use in children with asthma causes serious concerns in parents, leading to treatment non-adherence. This study aimed to investigate the effect of maternal anxiety and attitudes on adherence to ICS therapy in children with asthma. The patient group included the children with mild to moderate persistent asthma, aged 6-11 years. Healthy children in a similar age range were included as a control group. The patient group was divided into two categories (treatment adherent and non-adherent) according to the regularity of ICS use. All patients were assessed with Childhood-Asthma Control Test (C-ACT), and their mothers were assessed using Parent Attitude Research Instrument (PARI) and Beck's Anxiety Inventory (BAI). A total of 156 children (age: 7.4 ± 1.4 years, F/M: 71/85) with persistent asthma and 60 healthy children (age: 7.5 ± 1.3 years, F/M:25/35) were included in the study. The rate of adherence in children with asthma was 52.6%. Mothers of non-adherent patients had significantly higher BAI scores than those of the adherent patients and controls (p < 0.001 and p < 0.001, respectively). The number of mothers who indicated that they did not have enough information about asthma and treatment was also higher in the non-adherent group. PARI subtest scores were not different between the adherent and non-adherent groups. In our study, it was found that mothers' anxiety levels and their knowledge about asthma and medications were associated with treatment adherence in children with asthma. Psychological and educational support to the families of children with asthma would improve their treatment adherence and efficacy.

Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children.

Asthma is the most common chronic condition in childhood, and the recommended pharmacotherapy for long-term control includes the use of inhaled corticosteroids (ICS). ICS were designed to act at the site of inflammation in the lung, thus decreasing systemic absorption and reducing the risk of adverse effects associated with corticosteroid use (e.g., HPA suppression and its consequent effects). Available data show that measurement of hair cortisol successfully reflects endogenous cortisol levels. We sought to examine whether hair cortisol measurements can be used to identify HPA suppression surrounding ICS therapy in children with asthma. Hair samples were collected from the vertex posterior region of the head of 18 asthmatic children. We compared their hair cortisol concentration during ICS use with the concentration prior to ICS use. During ICS therapy, median hair cortisol levels were twofold lower compared with the period of no ICS use (median 89.8 ng/g vs. 198.2 ng/g, P = 0.0015). Hair cortisol is an effective biomarker of the HPA suppression associated with ICS therapy and can be a sensitive tool for determining systemic effects of ICS use and monitoring adherence. Future research is needed to characterize the effect of untreated asthma on hair cortisol concentrations, if any.

High degree of supervision improves adherence to inhaled corticosteroids in children with asthma.

PurposeAdherence to treatment with inhaled corticosteroids (ICS) is a critical determinant of asthma control. The objective of this study was to assess factors that determine adherence to ICS therapy in children with asthma.MethodsFifty-eight children with asthma, aged 5 to 16 years, used ICS with or without a spacer for 3 months. Adherence rates as measured from questionnaires and canisters, asthma symptom scores, and inhalation technique scores were assessed every 30 days. The degree of supervision by caregivers was assessed at day 30.ResultsAdherence rates measured using canisters were lower at day 60 than at day 30 (P=0.044) and did not change thereafter (74.4%±17.4% at day 30, 66.5%±18.4% at day 60, and 67.4%±22.2% at day 90). Adherence rates at days 60 and 90 and during the total study period were significantly different when measured by using questionnaires versus canisters (P<0.001, P=0.022, and P=0.001, respectively). In the comparison of adherence rates repeatedly measured at days 30, 60, and 90 and adherence rates during the total study period among the 3 groups, adherence rates in the high-degree supervision group were significantly higher than those in the low-degree supervision group (82.0±16.0 vs. 66.1±14.5, 75.4±14.4 vs. 56.2±18.4, 75.0±18.3 vs. 55.0±19.7 [P=0.027]; 77.9±12.2 vs. 59.1±11.4 [P=0.021]) after adjustment for sex and age.ConclusionThe level of caregiver supervision is an important factor affecting adherence to ICS therapy in children with asthma. Therefore, a high degree of supervision may be required to increase adherence to ICS therapy in children with asthma.

The Long-Term Effects of Inhaled Corticosteroid Treatment in Children With Asthma

Inhaled corticosteroids (ICS) are the preferred method of therapy for persistent asthma in children, providing the most effective anti-inflammatory treatment available. This article defines treatment with ICS in children and discusses current research findings related to the long-term side effects and safety concerns related to ICS therapy in children with asthma. Major safety concerns associated with long-term treatment with ICS include the potential effect on adrenal function, the inhibition of linear growth and growth velocity, osteoporosis, and ocular disorders. This article describes side effects associated with ICS and implications in pediatric primary care.

Inhaled corticosteroids do not prevent the development of asthma

Question In children with early wheezing, does the use of inhaled corticosteroids (ICS) prevent loss of lung function or reduce the incidence of asthma later in childhood? Design Randomized, double-blind, controlled study. Setting South Manchester, United Kingdom. Participants 1073 children were followed prospectively, of whom 333 were eligible, and 200 began treatment. One hundred and seventy-three completed follow-up at 5 years of age. Intervention Fluticasone propionate 100 μg twice daily in young children who were randomized after either one prolonged (>1 month) or two medically confirmed wheezy episodes. The dose of study drug was reduced every 3 months to the minimum needed. If the symptoms were not under control by 3 months, open-label fluticasone propionate 100 μg twice daily was added to the treatment. Outcomes Children’s lung function (specific airways resistance [sRaw], forced expiratory volume in 1 second [FEV1]) and airway reactivity (eucapnic voluntary hyperventilation [EVH] challenge). Main Results The groups did not differ significantly in the proportion of children with current wheeze, physician-diagnosed asthma or use of asthma medication, lung function, or airway reactivity (percentage change in FEV1, adjusted mean for placebo 5.5% [95% CI −2.5-13.4]) vs for treatment 5.0% [−2.2-12.2], P = .87). There were no differences in the results after adjustment for open-label fluticasone propionate, nor between the two groups in the time before the open-label drug was added (estimated hazard ratio 1.12 [95% CI 0.73–1.73], P = .60) or the proportion needing the open-label drug. Conclusions The early use of inhaled fluticasone propionate for wheezing in preschool children had no effect on the natural history of asthma or wheeze later in childhood, and it did not prevent lung function decline or reduce airway reactivity. Commentary Asthma is characterized by chronic airway inflammation and obstructive lung physiology that frequently cause symptoms in early childhood. Studies in school-aged children with mild to moderate asthma demonstrated that inhaled corticosteroid (ICS) therapy improves asthma symptoms and airway hyperreactivity, but it does not improve lung function.1The Childhood Asthma Management Program Research GroupLong-term effects of budesonide or nedocromil in children with asthma.N Engl J Med. 2000; 343: 1054-1063Crossref PubMed Scopus (1297) Google Scholar Therefore, it has been hypothesized that an earlier intervention with anti-inflammatory therapy may be able to alter the natural course of asthma and prevent the decline in lung function over time. The IFWIN study instituted ICS therapy in preschool children after their second wheezing episode and failed to show any difference in lung function or asthma diagnosis at 5 years of age compared with placebo. This agrees with two recent studies (PEAK2Guilbert T.W. Morgan W.J. Zeiger R.S. Mauger D.T. Boehmer S.J. Szefler S.J. et al.Long-term inhaled corticosteroids in preschool children at high risk for asthma.N Engl J Med. 2006; 354: 1985-1997Crossref PubMed Scopus (884) Google Scholar and PAC3Bisgaard H. Hermansen M.N. Loland L. Halkjaer L.B. Buchvald F. Intermittent inhaled corticosteroids in infants with episodic wheezing.N Engl J Med. 2006; 354: 1998-2005Crossref PubMed Scopus (477) Google Scholar) that also did not demonstrate improvement in pulmonary function with chronic or intermittent ICS therapy in children with early wheezing. These studies suggest that the predisposition to asthma may be set very early in life and/or that development of asthma is insensitive to the effects of corticosteroids. These early treatment approaches are complicated by the high incidence of wheezing in preschool children, and the fact that these “early wheezers” are a heterogeneous population from which only a subgroup will progress to chronic asthma. Despite these findings, it is important to point out that the evidence remains strong that ICS therapy improves control of asthma symptoms in preschool children. Therefore, judicious use of ICS in early childhood is still warranted in those with chronic wheezing in accordance with established guidelines for the treatment of childhood asthma.

Side effects of inhaled corticosteroids

Inhaled corticosteroid (ICS) therapy carries less risk of complicating drug- or disease-related morbidity and mortality than that associated with other antiasthmatic drugs such as prednisone, theophylline, or β 2 -agonist bronchodilators. Serious side effects are uncommon, but the risk increases with the daily dose. The degree of risk is most effectively minimized by ensuring each patient uses the smallest daily dose sufficient to maintain optimum control of their disease. Any patient in whom ocular symptoms develop while receiving ICS therapy should promptly be evaluated by an eye specialist. Growth velocity is commonly reduced during ICS therapy and should be monitored routinely. Bone metabolism may be affected by low or medium doses of ICS, but there is no evidence such doses cause osteoporosis or fracture. High-dose therapy may reduce bone density and increase the risk of fracture, particularly if other risk factors for osteoporosis are present. Research is needed to better define the impact of ICS therapy in children on height and peak bone density attained at maturity. Also, there is a need for practice guidelines specifically applicable to the prevention of bone loss during ICS treatment. (J Allergy Clin Immunol 1998;102:705-13.)