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March 17, 2009

AAAAI 2009: Inhaled Corticosteroids Sharply Cut Use of Rescue Medication in Asthmatic Children



Martha Kerr

March 16, 2009 (Washington, DC) — Regular use of mometasone furoate, delivered by dry-powder inhaler, immediately and significantly reduces the need for rescue medications to control symptoms of asthma in children 4 to 11 years old, and the need for rescue treatment remains consistently low over prolonged periods among those regularly using the inhaled corticosteroid.
"A reduction in rescue medication use is one of the goals of asthma therapy," William E. Berger, MD, from the Allergy and Asthma Associates of Southern California, in Mission Viejo, told attendees here at the 2009 American Academy of Asthma, Allergy and Immunology (AAAAI) Annual Meeting.
Dr. Berger's team randomized 296 children with mild to moderate persistent asthma to mometasone furoate 100 mg once a day at night (99 children), 100 mg twice a day (99 children), or placebo (99 children). Baseline albuterol use was low in all treatment groups, and averaged 1.3 puffs a day.
Patients receiving mometasone once nightly showed mean end-point reductions in rescue medication of 19.5%, and those receiving mometasone twice a day had a mean end-point reduction of 13.4%; patients in the placebo group experienced a mean increase in rescue medication use of 22.4% (P < .01).
The approved pediatric dose of inhaled mometasone furoate is 100 mg daily, and it is generally administered in the evening.
"Analysis of weekly data revealed clear patterns of albuterol-use reductions across the 12-week study period in both mometasone groups, but not in the placebo group," Dr. Berger said.
Rescue medication use was immediately reduced with the introduction of mometasone, and showed a progressive downward trend throughout the 12-week study.
"The National Heart, Lung, and Blood Institute considers the use of short-acting beta-2-agonists [SABAs] more than twice a week to be inadequate asthma control," Dr. Berger said. "In addition, extended use of SABA rescue medication may be associated with serious adverse events."
Costs of SABAs have gone up significantly recently because chlorofluorocarbon propellants in metered-dose inhalers have been discontinued and have been replaced by hydrofluoroalkane propellants, which are more expensive, he noted.
"Mometasone has an excellent safety record for children," Clifford Bassett, MD, chair of public education for the AAAAI, said in an interview with Medscape Allergy & Clinical Immunology.
"Good control of asthma is not a trivial thing. Asthma has a significant mortality rate. . . . Five thousand asthma patients died every year 10 years ago. Now it is about 3500 a year. The message is getting out," Dr. Bassett commented.
"The guidelines are being followed, and inhaled corticosteroids are the cornerstone of treatment," Dr. Bassett added. "A significant number of asthma patients are not symptomatic until they are really, really sick. The use of controller medications is very important."
Dr. Berger's study was funded by a grant from Schering-Plough, Inc. Dr. Bassett disclosed no relevant financial relationships.
2009 American Academy of Asthma, Allergy and Immunology (AAAAI) Annual Meeting: Poster 10. Presented March 14, 2009.


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