engleski

Based on what parameters of clinical remission should inhaled corticosteroids be stopped in children with asthma?

Limited number of studies have assessed how long treatment with inhaled corticosteroids (ICS) should be continued after clinical remission. Many people have persistent bronchial hyperreactivity (BHR)after clinical remission. Aims of this longitudinal study were to (1) determine if BHR was present one year after stopping ICS therapy , (2) compare FEV 1, PEF, type and duration of therapy in group of positive and negative methacholine test, (3) follow up patients for recurrence of asthma symptoms. Based on clinical parameters, normal spirometry results, daily peak expiratory flow (PEF) and negative bronchodilator test, ICS therapy was stopped in group of 40 children. After 6 to 12 months of total asthma control was achieved, step down and withdrawal of ICS treatment was introduced. One year after stopping therapy, methacholine challenge test was performed in all patients. Clinical course and lung function were followed 12 months after stopping of ICS. Positive methacholine test was noted in 20 patients (50%). There was no statistically significant difference between group of positive and negative methacholine test regarding age of starting and stopping ICS therapy, duration of ICS therapy, duration of stepping down period, FEV 1 and PEF at the time of withdrawal of ICS and one year later. In two patients from positive methacholine group, ICS treatment had to be reintroduced because of recurrence of asthma symptoms. Clinical parameters, normal spirometry, daily PEF values and negative bronchodilator test are good parameters to exclude ICS therapy in asthmatic children, even in group with persistent BHR. Children should be followed up since symptoms can recur.

Asthma - management, Children, Lung function testing

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