Preventing Asthma Exacerbations in Children
29
August

By Adem Lewis / in , , , , , , , , , /


In pediatric asthma management, early signs of loss of asthma control often portend an impending exacerbation-this condition is often referred to as entering the ‘yellow zone’. Escalation of asthma treatment in the yellow zone has been considered as a way to prevent full blown exacerbations, but there is limited
evidence to support this approach. This randomized, double-blind trial involved
254 children age 5 to 11-years with mild-moderate persistent asthma who were being treated with
daily low-dose inhaled glucocorticoids. When they entered the ‘yellow zone’, those
in the intervention group increased the dose of inhaled glucocorticoids by a factor
of 5 for a week. For those in the control group, the dose remained
unchanged. The primary outcome was the rate of asthma exacerbations leading to treatment with systemic glucocorticoids. That rate was not significantly different
between the two treatment groups, with 0.37 exacerbations/year reported in the low-dose group and 0.48 exacerbations/year in the high-dose group. The growth rate in children randomized to
high-dose inhaled glucocorticoids was 0.23 cm/year less than in children randomized to low-dose inhaled glucocorticoids. The authors conclude that increasing inhaled
glucocorticoid doses 5-fold for 7 days at the early signs of loss of asthma control
in children with persistent asthma being treated with daily low-dose inhaled glucocorticoid
therapy does not significantly reduce exacerbations and may be associated with adverse growth
effects in the children. Full trial results are available at NEJM.org


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