Step-by-step management of bronchial asthma children: step up or step down?

Abstract

This trial was aimed to a comparative evaluation of clinical efficiency of different approaches (step up and step down) to moderate bronchial asthma management in children.
This study was designed as a single-blinded randomized parallel-groups trial. It involved 50 children with moderate asthma aged from 6 to 15 years; they were divided into 2 groups. The 1st group patients received fluticazone propionate 200 meg daily for 12 weeks. Then they were transferred to the treatment with sodium cromoglicate in a dose of 20 mg daily (step down). The children included into the 2nd group received sodium cromoglicate as a starting therapy. The evaluation of the treatment efficacy was assessed in 4 weeks. When the initial treating course was declared to be successful the patients went on to receive the same drug for 20 weeks more (the 2A group). In a case of unsatisfactory effectiveness of the therapy with sodium cromoglicate the children were administrated fluticazone propionate for 12 weeks (step up) and then they were transferred to the cromoglicate therapy (the 2B group).
The trial protocol included an assessment of main asthmatic signs intensity, respiratory function parameters, severity of bronchoconstruction after exercise, a degree of metacholine-induced bronchial hyperresponsiveness and quality of the children’s life.
It was demonstrated that the step down approach is more preferable in moderate asthma children during basic anti-inflammatory therapy as far it facilitates to achieve the stable asthma condition in short time, to prevent successfully a bronchoconstruction after exercise and to reduce most significantly the bronchial hyperresponsiveness. All these conditions considerably improve the quality of the patients’ life. The replacement of fluticazone propionate to sodium cromoglicate in the children leads neither to worsening of asthma course nor to decreasing of expiratory flow value and does not cause a great reinforcement of bronchial hyperresponsiveness in overwhelming majority of patients as well.