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Can Inhaled Corticosteroids Prevent Asthma?
 Asthma,
the most common chronic childhood illness in the United States, is a breathing
disease in which the airways are inflamed, making breathing difficult. Studies
in older children and adults show that inhaled corticosteroids are the most effective
long-term control medicine for persistent asthma. These medicines reduce airway
swelling and help prevent asthma symptoms. Pediatricians and researchers have
wondered for years whether it can also be used to prevent the disease if it's
given early enough. A new study supported by NIH's National Heart, Lung and Blood
Institute (NHLBI) shows that, while they can reduce breathing problems in pre-school-aged
children at high risk for asthma, inhaled corticosteroids don't prevent the development
of persistent asthma.
Researchers have known that in most cases of chronic asthma, symptoms such as
frequent coughing, wheezing or shortness of breath begin during the first 3 years
of life. Declines in lung function can occur this early as well. However, few
studies have been done in children less than 4 years old.
In the new study, 285 children ages 2-3 at high risk for asthma were randomly
selected to receive either daily treatment of an inhaled corticosteroid — fluticasone
propionate (Flovent) — or a placebo for 2 years. All children in the study received
additional medication to treat any symptoms that arose. After 2 years, daily
use of the inhaled corticosteroids (or placebo) was stopped, and the children
were observed for an additional year to see if the earlier treatment had lasting
effects.
In the May 11 issue of the New England Journal of Medicine, the researchers
report no significant differences between the participants in the treatment group
and those in the placebo group during the observation period. During the two-year
treatment period itself, however, children treated with the daily inhaled corticosteroids
had significantly fewer and less severe asthma symptoms than their peers who
were given placebo.
Like an earlier report of older children, the study found that the inhaled corticosteroids
appeared to temporarily slow the growth of children in the treatment group. The
difference in growth was significant between the 2 groups during the first year
of the study, but not during the second year — and during the third-year observation
period, the children who had been regularly treated with inhaled corticosteroids
grew more quickly.
Inhaled corticosteroids don't seem to prevent asthma from developing in children
under 4 years of age. However, this study does show that inhaled corticosteroids
can prevent asthma symptoms in pre-school children at high risk for asthma.
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