© 2005 American Thoracic Society
Efficacy of Fluticasone Propionate on Lung Function and Symptoms in Wheezy InfantsTo the Editor:Hofhuis and colleagues compared the effect of inhaled fluticasone propionate 200 µg (FP200) daily versus placebo on lung function and symptoms in 62 wheezy infants (1). Based on their study the authors suggest that the lack of effect of FP200 on lung function is explained either by lack of room for improvement of lung function or through insensitivity of the lung function measurements that are currently available. By contrast, they show significant effects of FP200 on wheeze, dyspnea, and cough at 6 weeks. To establish the clinical relevance of the effects of FP200 on symptomatic infants some questions remain. First, the number of salbutamol puffs recorded on the diary card of the infants using FP200 or placebo is missing in the report. This secondary endpoint might indicate the relevance of symptoms of cough, wheeze, and dyspnea for the infants and their parents, as well as the relevance of the effects of FP on airway symptoms in infants. Second, the influence of environmental smoke exposure on symptoms suggestive of asthma in infants, like cough, wheeze, and dyspnea, was stressed in the study of Gergen and coworkers (2). What would be the effect of exclusion of the 12 (19%) infants exposed to environmental tobacco smoke (Hofhuis and coworkers' Table 1) on the effect of FP200 on cough, wheeze, and dyspnea in their patients? It was recently found that two weeks of treatment with FP reduces cough and other lower respiratory tract symptoms in subjects without asthma, but only in those who do not smoke (3). In a prospective, population-based study, Piipari et al. recently demonstrated that cigarette smoke reduces the efficacy of inhaled corticosteroids in subjects with asthma (4).
Third, the report of Hofhuis and coworkers clearly shows that the wheezy infants had stable symptoms of cough, wheeze, and dyspnea—all responsive to FP200—for a 6–8 week period, which were followed by spontaneous resolution of the symptoms in weeks 7–12. The infants suffered from intermittent symptoms of the lower respiratory tract, episodes that are frequently presented to general practitioners (GPs). Therefore, there appears to be a need as well for a study of the short-term (2–6 weeks) effects of ICS on cough, wheeze, and dyspnea in infants, compared with the recommended treatment regimen of
a Erasmus Medical Centre, Rotterdam, The Netherlands FOOTNOTES Conflict of Interest Statement: None of the authors have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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2-agonists. The number of infants studied should be sufficient for subgroup analyses on the interactions between environmental tobacco smoke exposure and allergy. It has been suggested that sensitization to inhalant allergens (determined by RAST) in 1–4-year olds who present with persistent cough to the general practitioner predicts asthma at the age of six years (