Step-Up Therapy for Poorly Controlled Asthma in Children

Study results, favoring long-acting β-agonists, are in tension with a recent FDA advisory.

When asthma in children remains uncontrolled after monotherapy with inhaled corticosteroids (ICS), what is the best next step? Researchers evaluated three step-up therapies in 165 children (age range, 6–17 years) whose asthma was poorly controlled after 2 to 8 weeks of low-dose fluticasone therapy (100 µg twice daily). In a double-blind triple-crossover clinical trial, the children were randomized to receive each of three therapies for 16 weeks: step-up ICS therapy with fluticasone (250 µg twice daily), low-dose fluticasone plus a long-acting β-agonist (LABA step-up; 50 µg daily), and low-dose fluticasone plus a leukotriene-receptor antagonist (LTRA step-up; 5–10 mg daily). The primary outcome was a composite of change in forced expiratory …

Reviewing Author

Howard Bauchner, MD

Disclosures

Grant / research supportHuman Resources and Services Administration; NIH; NIH-NHLBI; USDA; GlaxoSmithKline

Editorial boardsArchives of Disease in Childhood (Editor-in-Chief)

Howard Bauchner, MD

Disclosures

Grant / research supportHuman Resources and Services Administration; NIH; NIH-NHLBI; USDA; GlaxoSmithKline

Editorial boardsArchives of Disease in Childhood (Editor-in-Chief)

Step-Up Therapy for Poorly Controlled Asthma in Children

Topics

Reviewing Author