Intermittent steroid inhalation for the treatment of childhood asthma

Abstract

Inhaled corticosteroids have long been considered a mainstay of therapy for asthma in children. However, concerns over long-term side effects of chronic steroid administration have led providers to turn to intermittent dosing of these medications in an attempt to treat exacerbations while limiting total corticosteroid received. The data have been somewhat mixed in this area, likely at least partially due to the difficulty providers have in classifying asthma phenotypes in young children. This review will analyze the evidence for chronic daily inhaled corticosteroid use, intermittent inhaled corticosteroid use, and dynamic dosing approaches utilizing inhaled corticosteroid/long-acting beta agonist combination therapy.

Keywords:

• Episodic wheeze
• inhaled corticosteroids
• intermittent dosing

Acknowledgements

The authors would like to give a special thanks to Katherine Johnston, MPH, for her review of the manuscript.

Financial & competing interests disclosure

SJ Szefler is the recipient of grants from the National Institute of Allergy and Infectious Diseases, Inner City Asthma Consortium (ICAC) II N01-AI-90052 and N01 AI025496; National Heart, Lung and Blood Institute, 1U10HL098075, Asthma Research Network (AsthmaNet) and Colorado Cancer, Cardiovascular and Pulmonary Disease Grant #13-FLA-48556, Step Up Asthma program for the Denver Public Schools; has received personal fees for new drug development or meeting attendance or lectures from Merck, Boehringer-Ingelheim, GlaxoSmithKline, Genentech, Aerocrine, Novartis, Roche and the University of Colorado School of Medicine. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• The efficacy of continuously administered inhaled corticosteroids (ICS) has long been established; however, this comes at the price of side effects of the therapy, especially diminished growth velocity.

• The data for the use of intermittent ICS in children are mixed; however, in a certain phenotype of preschool, episodic/viral wheezers with little between-episode functional impairment, there may be some benefit to treatment with intermittent ICS only. Benefits of therapy may be dose and age dependent. Further study needs to be done regarding the cost–effectiveness of this therapy in this population.

• The long-term safety and efficacy of single inhaler inhaled corticosteroid/long-acting beta agonist for maintenance and rescue therapy will need to be further evaluated; this therapy could potentially be beneficial to asthmatic children.