INHALED STEROIDS COMPARED WITH DISODIUM-CROMOGLYCATE IN PRESCHOOL-CHILDREN WITH EPISODIC VIRAL WHEEZE

In school children with atopic asthma the beneficial effects of disodi um cromoglycate (DSCG) and beclomethasone dipropionate (BDP) are well- established. In preschool children, wheezing is quite common, and in t he majority of cases the symptoms are episodic and reported to be asso ciated with viral infections rather than atopy. We compared the effica cy of regular treatment with DSCG and BDP for prevention of wheezing i n preschool children. We were interested to establish whether regular treatment with inhaled anti-inflammatory drugs could lead to a decreas e in bronchial responsiveness. In 15 patients (median age, 56 months; range, 43-66 months) bronchial responsiveness was assessed by measurin g specific airway resistance (sR(aw)) during a histamine provocation t est. The concentration of histamine eliciting a 100% increase in sR(aw ) (PC100his)was determined. In a double-blind crossover study, patient s inhaled either DSCG 10 mg three times a day or BDP 100 mu g three ti mes a day for 2 months. After a wash-out period, treatment was changed to BDP or DSCG, respectively. Daily peak flow measurements were carri ed out, and exacerbations were noted. PC100his was measured at the sta rt and end of each treatment period. No significant decrease in bronch ial responsiveness was seen (PC100his DSCG: before 1.3, after 1.66 mg/ ml, P value not significant; BDP: before 1.1 after 1.22 mg/ml, P value not significant). Significantly higher morning peak flows were observ ed on BDP therapy (160 on BDP vs. 150 L/min on DSCG, P < 0.03). BDP tr eatment resulted in significantly fewer wheezing exacerbations (7 vs. 16, P < 0.005) compared with DSCG therapy. We conclude that in prescho ol children with episodic virally induced wheezing, BDP therapy was su perior to DSCG aerosol treatments for the prevention of exacerbations of wheezing, although no significant effect on bronchial responsivenes s was noted during either treatment protocol. (C) 1998 Wiley-Liss, Inc .