As-Needed Inhaler Use an Option for Children With Mild Asthma

Children with mild asthma can use inhalers as needed, according to a study published online in the Journal of Allergy and Clinical Immunology: In Practice.

Kaharu Sumino, M.D., from the Washington University School of Medicine in St. Louis, and colleagues randomly assigned 206 African-American children (ages 6 to 17 years) with mild asthma managed by 12 primary care providers (PCPs) to either symptom-based adjustment (SBA): as-needed beclomethasone 80 µg with rescue short-acting β-agonist; or provider-based guideline-directed adjustment (PBA): maintenance beclomethasone 80 µg/d (6 to 11 years old), 160 µg/d (12 to 17 years old), with subsequent guideline-based dose adjustment by PCPs.

The researchers found that at baseline, participants had adequately controlled asthma (mean Asthma Control Test [ACT] or childhood ACT [cACT] score, 21.6). There was no significant between-group difference after one year for change in ACT scores (SBA − PBA): ACT: −0.88 (95 percent confidence interval [CI], −2.19 to 0.42) and cACT: −0.73 (95 percent CI, −2.09 to 0.62), or combined ACT and cACT (P = 0.10). This was within the predefined statistical clinical equivalence. Exacerbation and measures of lung function were also similar between groups. SBA led to less beclomethasone use compared with PBA (SBA: 526 µg/month [95 percent CI, 412 to 639] versus PBA: 1,961 µg/month [95 percent CI, 1,681 to 2,241]; P < 0.0001). In the SBA group, more parents felt they were managing their child's asthma.

"Given the result of our study and others, primary care doctors may tell their patients with mild asthma that they have an alternative effective strategy other than taking the inhaled steroid every day, if they prefer not to do so," Sumino said in a statement.

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