Long-term budesonide or nedocromil treatment, once discontinued, does not alter the course of mild to moderate asthma in children and adolescents.
OBJECTIVE
To determine whether long-term, continuous use of inhaled anti-inflammatory medications affects asthma outcomes in children with mild to moderate asthma after use is discontinued.


METHODS
Of the 1041 participants in the Childhood Asthma Management Program randomized clinical trial, 941 (90%) were followed to determine whether 4.3 years of twice-daily budesonide or nedocromil administration (each compared with placebo) affected subsequent asthma outcomes during a 4.8-year posttrial period in which treatment was managed by the participants' physicians.


RESULTS
The groups treated continuously during the trial with either budesonide or nedocromil did not differ from the group given placebo in terms of lung function, control of asthma, or psychological status at the end of 4.8 years of posttrial follow-up. However, the decreased mean height in the budesonide group relative to the placebo group at the end of the trial (1.1 cm; P = .005) remained statistically significant (0.9 cm; P = .01) after an additional 4.8 years and was more pronounced in girls (1.7 cm; P = .001) than in boys (0.3 cm; P = .49). Participants in all groups used inhaled corticosteroids during 30% of the posttrial period.


CONCLUSIONS
Clinically meaningful improvements in the control of asthma and in airway responsiveness achieved during continuous treatment with inhaled corticosteroids do not persist after continuous treatment is discontinued.
Strunk
Robert C
RC
Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St. Louis, MO 63110, USA. strunk@kids.wustl.edu
Sternberg
Alice L
AL
Szefler
Stanley J
SJ
Zeiger
Robert S
RS
Bender
Bruce
B
Tonascia
James
J
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001827:Body Height; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D004363:Drug Utilization; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D017835:Nedocromil / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D011241:Prednisone / Q000627:therapeutic use; D012720:Severity of Illness Index; D012737:Sex Factors; D014797:Vital Capacity
D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D017835:Nedocromil; D019819:Budesonide; D011241:Prednisone