title: Risk factors associated with occurrence of clinical deterioration after cessation of beclomethasone in asthmatic children and adolescents.
abstract: Despite recent advances in the treatment of asthma using inhaled corticosteroids, the outcome for children after its discontinuation is not well known. This study aims to analyze the rate of clinical deterioration and related risk factors after beclomethasone withdrawal in asthmatic children and adolescents. One hundred two subjects with moderate or severe persistent asthma, who had started treatment with beclomethasone at the age of 2-11 years, were followed for 1 year after drug cessation. Depending on the occurrence of clinical deterioration, they were allocated to two groups, and then comparisons were made with respect to clinical criteria and skin prick test results. Statistical analysis was undertaken by using descriptive statistics and Cox's regression model. Treatment with beclomethasone had to be restarted in 28 patients (27.5%) because of relapse. There was a significant association with the risk of clinical deterioration with mother's history of asthma [hazard ratio (HR) = 2.19, 95% CI = 1.01-4.76, p = 0.04] and father's history of asthma and/or allergic rhinitis (HR = 2.34, 95% CI = 1.06-5.26, p = 0.03). A period shorter than 6 months without symptoms before prophylaxis cessation (HR = 2.26, 95% CI = 0.98-5.26, p = 0.05) and atopy (RH = 2.75, 95% CI = 0.94-7.69, p = 0.06) were also associated with risk of relapse but with marginal statistical significance. Results suggest that clinical benefits were maintained for at least 1 year in the majority of the children after the cessation of prophylaxis. Special attention must be given to those with atopy and a parental history of asthma and rhinitis because of the risk of clinical deterioration.
authors.affiliation: Federal University of Minas Gerais, Belo Horizonte, Brazil. teresamohallem@terra.com.br
authors.forename: Maria Teresa Mohallem
authors.initials: MT
authors.lastname: Fonseca
authors.forename: Paulo Augusto Moreira
authors.initials: PA
authors.lastname: Camargos
authors.forename: Laura Maria Belizario Facury
authors.initials: LM
authors.lastname: Lasmar
authors.forename: Enrico
authors.initials: E
authors.lastname: Colosimo
authors.forename: Marina Mohallem
authors.initials: MM
authors.lastname: Fonseca
mesh_terms: D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000209:etiology / Q000235:genetics / Q000503:physiopathology*; D001507:Beclomethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005220:Fathers; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000150:complications; D008297:Male; D008499:Medical Records; D009035:Mothers; D016016:Proportional Hazards Models; D019233:Retreatment; D012220:Rhinitis / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D018927:Anti-Asthmatic Agents; D001507:Beclomethasone