The effects of cromolyn sodium and nedocromil sodium in early asthma prevention

The possibility of irreversible obstruction and therefore the need for earl y intervention is being much debated, Some investigators suggested that del ay in starting inhaled corticosteroids will result in irreversible obstruct ion, Our own long-term study, specifically designed to detect irreversible obstruction showed that a step-wise approach (starting with cromolyn sodium and switching to inhaled corticosteroids if clinical control and pulmonary function tests are not satisfactorily controlled) resulted in an increase in pulmonary function and not a deterioration. There was no evidence that a delay in starting inhaled corticosteroids will result in irreversible obst ruction or clinical worsening. However, delay in starting cromolyn sodium i n patients treated with bronchodilators alone did result in worsening pulmo nary function tests and worse clinical outcomes. One study from Finland and another study from Australia came to the same conclusion. Even though some studies with cromolyn sodium did not show benefit in the first year of lif e, other studies did show a good response. The choice between nonsteroidal drugs, such as cromolyn sodium and inhaled corticosteroids as first-line dr ugs, has to be made on the risk/benefit ratio of these drugs. Although in s evere asthma inhaled corticosteroids have greater efficacy, in mild-to-mode rate asthma there is comparable efficacy, and the nonsteroidal drugs have b etter safety, A step-wise approach is still a logical approach (J Allergy C lin Immunol 2000;105:S575-85.).