Am. J. Respir. Crit. Care Med., Volume 164, Number 11, December 2001, 2073-2077

One-Year Treatment with Different Dosing Schedules of Fluticasone Propionate in Childhood Asthma
Effects on Hyperresponsiveness, Lung Function, and Height

MARTIN J. VISSER, DIRKJE S. POSTMA, LIDIA R. ARENDS, TJALLING W. DE VRIES, ERIC J. DUIVERMAN, and PAUL L. P. BRAND

Department of Pulmonology and Pediatric Pulmonology, University Hospital, Groningen; Department of Epidemiology and Biostatistics, Erasmus University, Rotterdam; Department of Pediatrics, Medical Center, Leeuwarden; and Department of Pediatrics, Division of Pediatric Pulmonology, Isala Klinieken, Zwolle, The Netherlands

Dose-dependent effects of inhaled corticosteroids have been described. Although it has been advised to start treatment with inhaled corticosteroids with a high dose tapering off subsequently (stepdown approach), no clinical studies have assessed this strategy. We compared two different dosage schedules of inhaled fluticasone propionate (FP) in chronic persistent childhood asthma with respect to efficacy (airways hyperresponsiveness [PD₂₀], lung function, exhaled nitric oxide [eNO]) and safety (height). During this double-blind study, children with asthma (aged 6-10 yr) were randomized to receive either FP 200 µg/d (constant dose approach) or to start with 1000 µg/d with two monthly reductions to 500, 200, and 100 µg/d (stepdown approach). PD₂₀ improved in both approaches during treatment with FP, with a significantly better PD₂₀ after 2 mo of 1000 µg/d followed by 500 µg/d in the stepdown approach versus 200 µg/d in the constant dose approach. No significant differences in PD₂₀ or other efficacy parameters were found after 1 yr. Changes in standing height were similar in both treatment approaches. This study showed no superior clinical effect of a stepdown approach compared with a constant dose strategy of FP for 1 yr in children with chronic persistent asthma.

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