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Research Review

Treatment for Childhood Asthma is Not One-Size-Fits-All

A new study has found the addition of long-acting beta-agonist therapy to be the most effective of three step-up, or supplemental, treatments for children whose asthma is not well controlled on low doses of inhaled corticosteroids alone. The results are published online in The New England Journal of Medicine.

The NHLBI's Guidelines for the Diagnosis and Management of Asthma (EPR-3) recommend three treatment options for children with mild to moderate persistent asthma  whose asthma is not well controlled on low doses of inhaled corticosteroids.  These treatments, which were featured in the study, are adding a long acting beta agonist to the low-dose inhaled corticosteroids; adding a leukotriene receptor antagonist to the low-dose inhaled corticosteroids; and doubling the dose of inhaled corticosteroids. These recommendations were based on data collected from adults.

The study compared how effectively the three different step-up treatments improved asthma control in 182 children aged 6 to 18. All participants had mild to moderate persistent asthma that was not controlled on low-dose inhaled corticosteroids. Participants received each of the three treatments, with each treatment period lasting 16 weeks.

Responses were measured based on three factors: number of asthma episodes requiring oral corticosteroids, number of days of well controlled asthma, and lung function as measured by the amount of air exhaled in one second.
Nearly all the children responded differently to the three treatments, with 45% of children responding best to adding a long-acting beta-agonist, 28% responding best to adding leukotriene receptor antagonist, and 27% responding best to doubling the dose of inhaled corticosteroids.
"This study underscores the fact that individuals respond differently to different therapies—childhood asthma treatment is not one-size-fits-all," said Robert F. Lemanske, Jr., MD, of the University of Wisconsin Hospital-Madison, one of the principal investigators of the study and lead author.  "It is important to monitor the child's response closely and, if necessary, adjust therapy with one of the other options within this step of care before moving to a higher step of care."

— Source: National Institutes of Health, the National Heart, Lung, and Blood Institute