Do current treatment protocols adequately prevent airway remodeling in children with mild intermittent asthma?

Background: Asthma treatment per Global Initiative for Asthma (GINA) guidelines targets airway remodeling and achievement of normal lung function. Objective: To study inhaled steroid therapy on airway remodeling and achievement of normal lung function. Subjects and set up: Asthmatic patients were followed over 5 years The children were divided into two groups. Group I (148 children-treated group) consisted of all the children using inhaled steroids on a regular basis and group II (50 children-untreated group) included patients with mild intermittent asthma who did not use inhaled steroids and were treated with bronchodilators as needed. Detailed medication and compliance history were recorded and the children underwent regular pre- and post-bronchodilator spirometry and physician examination. Results: The incidence of airways remodeling as defined by the low FEV1/FVC postbronchodilator was markedly increased over the 5-year period in the untreated group compared to the treated group. In the treated group the FEV1/FVC ratio postbronchodilator decreased from 35% to 20.9% (P < 0.009%) compared with the untreated group where the number of children with low FEV1/FVC postbronchodilator increased from 10% to 28% by the end of the study period. Conclusion: Patients with mild asthma who do not receive regular inhaled steroids are at increased risk for airway remodeling. Therefore, we recommend that children with mild intermittent asthma undergo regular pulmonary function testing and that if any deterioration is detected in the FEV1/FVC ratio post- bronchodilators; preventative inhaled corticosteroid therapy be initiated. (c) 2005 Elsevier Ltd. All rights reserved.