Daily inhaled corticosteroids are recommended for young children at risk for asthma exacerbations and an exacerbation in the preceding year. However, concerns remain about effects on growth. This study published in the NEJM compared daily therapy with intermittent therapy with nebulized budesonide in 278 children aged 12 to 53 months. All of them had positive modified asthma predictive index (API), recurrent wheezing episodes, and at least one exacerbation in the previous year but a low degree of impairment.
Modified Asthma Predictive Index (API) (click to enlarge the image).
They were randomly assigned to receive a budesonide inhalation suspension for 1 year as either an intermittent high-dose regimen (1 mg twice daily for 7 days, starting early during respiratory tract illness) or a daily regimen (0.5 mg nightly).
The daily regimen of budesonide 0.5 mg did not differ significantly from the intermittent regimen with in terms of exacerbations or adverse events.
The authors concluded that a daily low-dose regimen of budesonide 0.5 mg was not superior to an intermittent high-dose regimen (1 mg twice a day) in reducing asthma exacerbations. This is an important development especially considering that the mean exposure to budesonide was 104 mg less with the intermittent regimen.
Asthma Inhalers (click to enlarge the image).
Daily or Intermittent Budesonide in Preschool Children with Recurrent Wheezing. N Engl J Med 2011; 365:1990-2001, November 24, 2011.