Lung

, Volume 184, Issue 2, pp 63–72 | Cite as

Effects of Early Intervention with Inhaled Sodium Cromoglycate in Childhood Asthma

  • S. Yoshihara
  • N. Kanno
  • Y. Yamada
  • M. Ono
  • N. Fukuda
  • M. Numata
  • T. Abe
  • O. Arisaka
Article

Abstract

International and Japanese guidelines classify childhood asthma as mild, moderate, or severe, and recommend treatment with “as needed” bronchodilators, inhaled sodium cromoglycate, and inhaled corticosteroids, respectively. Alternatively, some investigators proposed inhaled corticosteroids as first-line therapy to prevent airway inflammatory obstruction. This article describes a clinical study assessing the effect of early intervention with inhaled sodium cromoglycate in childhood asthma. This was a retrospective study of 189 asthmatic children treated with inhaled sodium cromoglycate for five years and whose age of onset of asthma was six year of age or younger. An end-of-study questionnaire completed the examination. Children administered oral or inhaled corticosteroids simultaneously with sodium cromoglycate, were excluded. Asthma scores as defined by the Japanese Pediatric Allergic Committee, were reduced continuously during the five years after the start of sodium cromoglycate treatment. The frequency of emergency department visits and hospitalizations also decreased. Significant between-period intervention differences showed improvement of clinical outcomes for children with severe asthma during the five years of sodium cromoglycate inhalation. The early intervention regime of starting sodium cromoglycate inhalation within two years of the onset of asthma shows a large improvement in the long-term prognosis of childhood asthma, especially for children with severe asthma. It is possible that starting inhaled sodium cromoglycate earlier than the present recommendation of corticosteroids could further improve clinical outcomes, but a prospective study should be performed to verify our results.

Keywords

Sodium cromoglycate Children Asthma Early intervention  Clinical study 

References

  1. 1.
    Agertoft L, Pedersen S (1994) Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med 88:73–381Google Scholar
  2. 2.
    Barnard AB (1983) Cromolyn: past present and future. Pediatr Clin North Am 30:915–930Google Scholar
  3. 3.
    Childhood Asthma Management Program Research Group (1999) The childhood asthma management program (CAMP): design, rationale, and methods. Control Clin Trials 20:91–120Google Scholar
  4. 4.
    Childhood Asthma Management Program Research Group (2000) Long-term effects of budesonide or nedcromil in children with asthma. N Engl J Med 343:1054–1063Google Scholar
  5. 5.
    Cockcroft DW, Murdock KY (1987) Comparative effects of inhaled salbutamol, sodium cromoglycate, and beclomethasone dipropionate on allergen-induced early asthmatic responses, late asthmatic responses, and increased bronchial responsiveness to histamine. J Allergy Clin Immunol 79:734–740CrossRefPubMedGoogle Scholar
  6. 6.
    Furusho K, Nishikaw K, Sasaki S, et al. (2002) The combination of nebulized sodium cromoglycate and salbutamol in the treatment of moderate-to-severe asthma in children. Pediatr Allergy Immunol 13:209–216CrossRefPubMedGoogle Scholar
  7. 7.
    Holt PG, Sly PD (2000) Prevention of adult asthma by early intervention during childhood: potential value of new generation immunomodulatory drugs. Thorax 55:700–703CrossRefPubMedGoogle Scholar
  8. 8.
    Hoshino M, Nakamura Y (1997) The effect of inhaled sodium cromoglycate on cellular infiltration into the bronchial mucosa and the expression of adhesion molecules in asthmatics. Eur Respir J 10:858–865PubMedGoogle Scholar
  9. 9.
    Hoshino M, Nakamura Y, Sim JJ, Tomioka H (1998) A comparative study of the effects of ketotifen, disodium cromoglycate, and beclomethazone dipropionate on bronchial mucosa and asthma symptoms in patients with atopic asthma. Respir Med 92:942–950PubMedGoogle Scholar
  10. 10.
    König P, Shaffer J (1996) The effect of drug therapy on long-term outcome of childhood asthma: A possible; preview of the international guidelines. J Allergy Clin Immunol 98:1103–1111PubMedGoogle Scholar
  11. 11.
    Korhonen K, Korppi M, Remes ST, Reijonen TM, Remes K (1999) Lung function in school-aged astmatic children with inhaled cromoglycate, nedocromil and corticosteroid therapy. Eur Respir J 13:82–86CrossRefPubMedGoogle Scholar
  12. 12.
    Mackenzie CA, Weinberg EG, Tabachnik E, et al. (1993) A placebo controlled trial of fluticazone propionate in asthmatic children. Eur J 152:856–860CrossRefPubMedGoogle Scholar
  13. 13.
    Makino S, Furusho K, Miyamoto T, Ohta K (2000) Asthma Prevention and Management Guidelines 1998, Japan (JGL 1998). Int Arch Allergy Immunol 121:1–78Google Scholar
  14. 14.
    National Asthma Education and Prevention Program (1997) Expert panel report 2: guidelines for the diagnosis and management of asthma. National Heart, Lung, and Blood Institute, Bethesda, MD, NIH Publ. No. 97–4051Google Scholar
  15. 15.
    Nishikawa K (1988) The effects of regular inhalation of disodium cromoglycate (DSCG) and salbutanol in Revere and intractable asthma patients. Jpn J Pediatr Allergy Clin Immunol 2:60–68Google Scholar
  16. 16.
    Overbeek SE, Kerstjens HAM, Bogaad JM, Mulder P, Postma DS (1996) Is delayed introduction of inhaled corticosteroids harmful in patients with obstructive airways disease (asthma and COPD)? The Dutch CNSLD Study Group. The Dutch Chronic Nonspecific Lung Disease Study Groups. Chest 110:35–41PubMedGoogle Scholar
  17. 17.
    Selroos O, Pierinalho A, Lofroos AB, Riska H (1995) Effect of early vs late intervention with inhaled corticosteroids in asthma. Chest 108:1228–1234PubMedGoogle Scholar
  18. 18.
    Waalkens HJ, Van Essen-Zandvliet EE, Hughes MD, et al. (1993) Cessation of long-term treatment with inhaled corticosteroid (budesonide) in children with asthma results in deterioration. The Dutch CNSLD Study Group. Am Rev Respir Dis 148:1252–1257PubMedGoogle Scholar
  19. 19.
    Warner JO (1992) Asthma: a follow up statement from an international paediatric asthma consensus group. Airch Dis child 67:240–248Google Scholar
  20. 20.
    Zeiger RS, Dawson C, Weiss S (1999) Relationships between duration of asthma and asthma severity anjiong children in the Childhood Asthma Management Program. J Allergy Clin Immunol 103:376–387CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • S. Yoshihara
    • 1
  • N. Kanno
    • 1
    • 2
  • Y. Yamada
    • 1
  • M. Ono
    • 1
  • N. Fukuda
    • 1
  • M. Numata
    • 1
  • T. Abe
    • 1
  • O. Arisaka
    • 1
  1. 1.Department of PediatricsDokkyo University School of MedicineShimotsuga-gunJapan
  2. 2.Department of PediatricsNishikata HospitalTochigiJapan

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