Combination therapy effective for asthma rescue

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Children with well-controlled mild asthma who were administered a rescue therapy consisting of albuterol and an inhaled corticosteroid, experienced 35% fewer exacerbations and 60% less treatment failures compared with placebo, study results indicate, but without the growth inhibition associated with daily-inhaled corticosteroids

"Inhaled corticosteroids as rescue medication with albuterol might be an effective step-down strategy for children with well controlled mild asthma because it is more effective at reducing exacerbations than is use of rescue albuterol alone," Fernando D. Martinez, MD, and colleagues from the University of Arizona in Tuscon, wrote in Lancet.

Although daily-inhaled corticosteroids remain the most effective method for controlling mild, persistent asthma, some children continue to have exacerbations or discontinue treatment after becoming asymptomatic, according to background information in the article.

Current guidelines recommend weaning children from inhaled corticosteroids after achieving asthma control, but a timeline for optimal treatment and discontinuation has yet to be established, the researchers wrote.

In an effort to determine whether rescue therapy with beclomethasone plus albuterol was more effective than albuterol alone, they compared the time to first exacerbation requiring oral corticosteroids among 288 patients aged 6 to 18 years. Participants were randomly assigned to one of four treatment regimens for 44 weeks:

  • Twice-daily beclomethasone with beclomethasone-albuterol rescue (combined therapy, n=71)
  • Twice-daily beclomethasone with placebo-albuterol rescue (daily therapy, n=72)
  • Twice-daily placebo with beclomethasone-albuterol rescue (beclomethasone rescue, n=71)
  • Twice-daily placebo with placebo-albuterol rescue (placebo, n=74).

The researchers found that the probability of an exacerbation before the end of the study was 49% among the placebo group, compared with 28% in the daily therapy group (P=0.03), 31% in the combined therapy group (P=0.07) and 35% in the beclomethasone rescue group (P=0.07).

Treatment failure was as follows: 23%, placebo; 5.6%, combination (P=0.012); 2.8%, daily therapy (P=0.009); and 8.5% in the rescue group (P=0.024).

The daily and combined therapy groups experienced 1.1 cm less linear growth than patients in the placebo group (P<0.0001); however, rescue group growth rates were not significantly different from placebo.

These findings could change the way that asthma is managed in children William Checkley, MD, of Johns Hopkins University in Baltimore, wrote in an accompanying editorial. He noted that the combination strategy proposed by Martinez et al, “would achieve reduction in overall cumulative exposure to inhaled corticosteroids and obviate concerns about compliance with long-term controller treatment.”

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