No evidence that early use of inhaled corticosteroids reduces current asthma at 10 years of age.
BACKGROUND
It is debated whether early treatment with inhaled corticosteroids (ICS) can change the natural course of childhood asthma.


OBJECTIVE
To assess if ICS treatment before 2 years of age in children with obstructive airways disease reduces current asthma at 10 years of age.


METHODS
Children with (n=233) and without (n=219) recurrent (r) bronchial obstruction (BO) attending clinical examination at 2 years of age in the birth cohort Environment and Childhood Asthma study in Oslo, were reinvestigated at 10 years of age. Current asthma (CA) at 10 years was defined as asthma with either symptoms and/or asthma treatment during the last year, and/or 10% fall in forced expired volume in 1s after standardized treadmill run. The risk of CA was assessed by logistic regression and propensity modelling (including gender, parental atopy and severity score at 2 years) in children with rBO who received ICS or not by 2 years.


RESULTS
CA was found in 97 children, more often among rBO children with (56.9%) and without ICS treatment (30.8%) compared to no-BO children (5.5%) (p<0.001). In rBO children logistic regression analyses (adjusted odds ratio aOR (95% confidence interval)) identified male gender (aOR 1.82 (1.01-3.27), p=0.046) and severity score at 2 years 1.14 (1.03-1.28), (p=0.01), as significant and ICS treatment as non-significant 2.00 (0.98-4.12) risk factors for CA. With propensity modelling adjusting for disease severity, ICS treatment by 2 years caused a non-significant increased risk aOR of CA of 1.84 (0.89-3.82).


CONCLUSIONS
No evidence was found that early use of ICS before age two in children with rBO reduces current asthma 8 years later.
Devulapalli
Chandra Sekhar
CS
Department of Paediatrics, Division of Woman and Child, Ullevål University Hospital, Oslo, Norway.
Lødrup Carlsen
Karin C
KC
Håland
Geir
G
Munthe-Kaas
Monica C
MC
Pettersen
Morten
M
Mowinckel
Petter
P
Carlsen
Kai-Håkon
KH
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000517:prevention & control; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents