Pilot study: The effect of reducing treatment on exercise induced bronchoconstriction

• Published in: Pediatric pulmonology Vol. 45; no. 9; pp. 927 - 933
• Main Authors: Kersten, E.T.G., Driessen, J.M.M., van Leeuwen, J.C., Thio, B.J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.09.2010; Wiley-Liss; Wiley
• Subjects: Administration, Inhalation; Adolescent; Adrenal Cortex Hormones - administration & dosage; Adrenergic beta-2 Receptor Agonists - administration & dosage; asthma; Asthma, Exercise-Induced - drug therapy; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Child; children; Chronic obstructive pulmonary disease, asthma; Drug Administration Schedule; Drug Therapy, Combination; Female; General aspects; Humans; inhaled corticosteroid; long acting bronchodilator agent; Male; Medical sciences; Pharmacology. Drug treatments; Pilot Projects; Pneumology; Human; Physical exercise; Lung disease; Corticosteroid; Pediatrics; long acting bronchodilator agent; Respiratory disease; Bronchodilator; inhaled corticosteroid; Asthma; Inhalation; Induced bronchoconstriction; Treatment; children; Bronchus disease; Obstructive pulmonary disease; Child; Pneumology; Medicine
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.21278

Rationale Asthma therapy should be stepped up or stepped down in response to changes in asthma control. However, there is little evidence available on the optimal timing, sequence, and degree of medication reductions. In this study we analyzed clinically stable asthmatic children who underwent a medication reduction from a combination preparation consisting of an inhaled corticosteroid (ICS) and long acting beta2‐agonist (LABA) to monotherapy with the same dose of the ICS. We hypothesized that the extent of exercise‐induced bronchoconstriction (EIB) would not increase after the cessation of the LABA. Methods Nineteen children, aged 8–16 years, with clinically stable asthma, receiving LABA/ICS combination therapy, were analyzed in this open‐label pilot study. Children performed an exercise challenge at baseline and 3 weeks after the medication reduction. Best values of spirometric measurements of the forced expiratory volume in 1 sec (FEV1) were used for statistical calculations. Results Maximum percent fall in FEV1 was significantly lower after 3 weeks of ICS monotherapy (P = 0.03). Eight of 19 children had a ≥15% fall in FEV1 after exercise at the initial exercise challenge. In this subgroup, maximum percent fall in FEV1 after the medication reduction was significantly lower (P < 0.01), and in six children it decreased to <15%, indicating they no longer had EIB. Conclusion In clinically stable asthmatic children on LABA/ICS combination therapy, the cessation of the LABA can reduce and in most cases abolish EIB. Pediatr. Pulmonol. 2010; 45:927–933. © 2010 Wiley‐Liss, Inc.