The effect of drug therapy on long-term outcome of childhood asthma: A possible preview of the international guidelines

Background: International guidelines classify childhood asthma as mild, moderate, and severe and recommend treatment with ''as needed'' bronchodilators, cromolyn sodium, and inhaled corticosteroids, respectively. Recently, some investigators proposed inhaled corticosteroids as first-line therapy to avoid possible irreversible airway obstruction. This article describes a retrospective study assessing the effect of the guidelines' approach on the long-term outcome of childhood asthma and the possible effect of delaying initiation of administration of corticosteroids. Methods: A retrospective review was performed on the charts of 175 children, and an end-of-study questionnaire plus results of spirometry completed the data. The mean age at start of study was 6.5 years, and the children were followed up for 2.2 to 16.8 years (mean, 8.4 years). Treatments included bronchodilators as needed only (patients with mild asthma), cromolyn sodium (patients with model-ate asthma) and inhaled corticosteroids (patients with severe asthma). Results: Frequency of symptoms, unscheduled doctors' visits, emergency department visits, hospitalizations, and missed school days decreased for the whole group. Statistically significant between-treatment differences favored both antiinflammatory therapies over as-needed bronchodilator treatment (cromolyn sodium: symptoms, p < 0.05; hospitalizations, p < 0.05; corticosteroids: emergency department visits, p < 0.05; hospitalizations, p < 0.05). Mean spirometry results improved, and the postbronchodilator values approached normal by study end. Assessed by treatment, spirometry decreased with bronchodilators but improved in patients treated with cromolyn sodium or inhaled corticosteroids. Delay in starting administration of cromolyn sodium had an unfavorable effect on clinical outcomes (p < 0.01) and spirometry (p < 0.05); delay in starting administration of corticosteroids did not. Conclusions: Treatment with antiinflammatory drugs (cromolyn sodium or inhaled corticosteroids), but not as-needed bronchodilators alone, improves the long-term prognosis of asthma. It is possible that starting administration of nonsteroid antiinflammatory agents earlier than the present recommendations could further improve clinical outcomes, but prospective studies are needed.