Steroid sparing using safer drugs in the management of children and adolescents with chronic asthma

摘要

The study included forty five (19 males and 26 females) children and adolescent patients (mean age 11.2+-3.4 years) suffering from chronic bronchial asthma, in whom oral and/or inhaled steroids were necessaary to control their symptoms. They were selected from patients attending outpatient clinics of Pediatrics and Chest Departments of Tanta University Hospital. They were assigned randomly into 3 treatment groups (15 cases each); Lidocaine group receiving nebulized lidocaine 1 mg/kg/dose twice dialy, Montelukast group receiving oral montelukast 5 mg once daily, and control group who continued on their traditional drugs (bronchodilators and steroids). History and clinical examination were performed and the following investigations were done to all study cases base line and after 2 weeks of treatment: PEFR, FEV_1, FEV(25-75%). Induced sputum was collected and utilized to do sputum eosinophil count, sputum eisinophilic cationic protein (ECP) and sputum nitric oxide (NO) metabolites (nitrites and nitrates). PEFR increased significantly 20 minutes after lidocaine inhatation, indicating bronchodilating effect of lidocaine. Studied pulmonary function parameters (PEFR, FEV_1 and FEV(25-75%) significantly increased, while induced sputum analysis data (sputum eosinophil count % and sputum ECP) significantly decreased after treatment in lidocaine and montelukast groups as compared to base line values and control group. However, the difference between the two groups after treatment was insignificant. Sputum total nitrites/nitrates did not change significantly after treatment in both groups and in controls due to pretreatment of all study cases with steroids. Successful steroid withsrawal was obtained in 86% of lidocaine group and 73% of montelukast group along of 2 weeks. The difference between success rates in the two groups was statistically insignificant (p>0.05). In conclusion, the present study suggests that both nebulized lidocaine and oral montelukast could be reasonable steroid sparing agents allowing maintained asthma control with no or reduced dose of steroids. Lidocaine is cheep while montelukast is easily administered in children. Both agents exhibited comparable steroid sparing actions without significant side effects. However, lidocaine inhalation works as asthma reliever as well due to its bronchodilating action.