Study objective: Many children with asthma go into
long-term clinical remission at adolescence, but bronchial
hyperresponsiveness (BHR) persists in some of these subjects. The
regular use of inhaled corticosteroids improves BHR in patients with
symptomatic asthma. The aim of this study was to determine whether BHR
in adolescents with asthma remission could be reduced by prolonged
treatment with inhaled corticosteroids.
randomized, double-blind, placebo-controlled, parallel study.
Patients: Thirty-seven adolescents with BHR and long-term
remission of their asthma (neither symptoms nor any medication use
during the previous 2 years).
received inhaled budesonide (two 200-μg puffs bid; budesonide group,
n = 19) or identical placebo (placebo group, n = 18) for 9 months.
A separate group of patients with symptomatic asthma (symptomatic
group, n = 19), using the same regimen of budesonide, was also
Measurements and results: The provocative
concentration of methacholine producing a 20% fall in FEV1
(PC20) was measured before and every 3 months during
treatment. There was no significant difference among the three groups
for the baseline PC20. In neither the placebo nor the
budesonide group did the geometric mean of PC20 change
significantly over the 9-month period. In contrast, a significant
increase in PC20 was noted in the symptomatic group as a
result of the budesonide treatment.
data have shown that budesonide inhaled regularly for 9 months did not
cause a significant improvement in the BHR of adolescents with
long-term asthma remission. This suggests that the mechanism underlying
BHR in this clinical setting may be different from that in symptomatic