Remission of childhood asthma after long-term treatment with an inhaled corticosteroid (budesonide): can it be achieved? Dutch CNSLD Study Group

Abstract

This study was undertaken in order to determine whether long-term treatment with inhaled corticosteroid can induce a remission in childhood asthma, and to decide when stabilization of airway responsiveness occurred. We therefore carried out, an extended follow-up of 28-36 months in one of two groups of children who participated in a long-term intervention study. This former study had shown that long-term (median follow-up 22 months) treatment with inhaled corticosteroid plus beta 2-agonist improves symptoms, airway calibre and airway responsiveness in children with asthma, compared with beta 2-agonist alone. On treatment with inhaled corticosteroid plus beta 2-agonist, airway calibre did not further improve after 4 months, whereas the provocative dose of histamine which causes a 20% fall in forced expiratory volume in one second (PD20) histamine showed gradual improvement without reaching an apparent plateau. Remission was defined as being symptom free during any 8 month period. Of the 58 children originally randomized to receive 0.2 mg salbutamol, plus 0.2 mg budesonide, t.i.d., five children withdrew: three due to lack of motivation, one for psychological reasons, and one due to a deterioration of asthma. One patient was hospitalized because of an asthma exacerbation. Airway calibre showed no improvement after 4 months up to 36 months. Mean PD20 histamine stabilized after 20 months at 2.1 doubling doses above baseline, but at a subnormal level of 80 micrograms. Symptoms improved during the first 18 months, and may have been improving further, but slowly, during the period between 18 and 36 months.(ABSTRACT TRUNCATED AT 250 WORDS)